Management of lung cancer

Gustave Roussy treats patients with lung, pleural and mediastinal cancer, such as:
 

• Adult bronchopulmonary cancers: non-small cell and small cell carcinomas
• Pleural tumours: mesothelioma and others
• Mediastinal tumours: thymoma and others
• Pleuropulmonary metastases requiring local treatment (committee-coordinated management depending on the primary tumour site)

The International Thoracic Cancer Centre

Gustave Roussy has joined forces with the Marie-Lannelongue Hospital and the Paris Saint-Joseph Hospital, also internationally acclaimed stakeholders, pooling their complementary skills to create the International Thoracic Cancer Centre (CICT). This healthcare collaboration offers a comprehensive care package to patients predisposed to or suffering from lung, pleural or mediastinal cancers.  

The CICT combines:

Gustave Roussy's expertise in oncology management and radiotherapy for thoracic cancers

• The expertise of the Marie-Lannelongue Hospital in the surgical management of thoracic cancers
• The expertise of the Paris Saint-Joseph Hospital in the global management of pulmonology

 Gustave Roussy is also the coordinating institution of RYTHMIC, the national network dedicated to thymic tumours, approved by the French National Cancer Institute. 

Rapid diagnosis of lung cancer

Working in conjunction with CICT member hospitals, Gustave Roussy offers rapid diagnosis of lung cancer and other thoracic cancers: the Instadiag pathway. Dedicated to patients whose abnormal CT findings are indicative of cancer, the Instadiag pathway ensures the comprehensive organisation of all the examinations needed for each patient in order to establish diagnosis and corresponding treatment as quickly as possible. This includes in particular:
 

• a biopsy, if deemed necessary, using the most appropriate technique for each situation: bronchial fibroscopy, transbronchial echo-endoscopy (TBE) or CT-guided biopsy.
• close collaboration with anatomopathology physicians to diagnose cancer as well as tumour phenotype and genotype
• the use of a reactive technical platform, imaging assessments to investigate disease spread and to conduct exploratory pulmonary and cardiovascular investigations prior to surgery or radiotherapy.

 If cancer is diagnosed, treatment is decided with colleagues in a multidisciplinary meeting. Multiple treatments are generally introduced based on good practice recommendations and up-to-date research data. 
 ► More information about lung cancer treatments 

Clinical research on thoracic tumours

Our doctors are heavily involved in national and/or international clinical trials. These trials help to develop future treatments for lung and other thoracic cancers. Some of our doctors also belong to working groups involved in establishing the SOR (Standards, Options, Recommendations) coordinated by the Unicancer network as well as European and international working groups. 

Support for patients and their families

Gustave Roussy is a partner of monreseau-cancerdupoumon.com, a secure social network dedicated to lung cancer patients and their families. 

Lung cancer treatment

Patients with lung, pleural or mediastinal cancer may be offered different treatments, depending on the type of cancer and its spread or stage at the time of diagnosis. Treatments may be combined during therapy.

Local treatments

Surgery

The aim of surgery is to remove the entire tumour. Depending on the extent of the cancer, either part of the lung or the entire lung is removed. A complete lymph node dissection is also performed. The purpose of surgery is to complete tumour resection by removing any tumour lymph nodes. General treatment may be considered after the procedure.

Radiotherapy

Radiotherapy aims to destroy tumour cells using ionising radiation. Modern techniques use powerful radiation beams that precisely target the tumour through the skin while preserving the organs. 
Radiotherapy is the recommended treatment for early-stage cancers when surgery is not an option. It can also be used to treat some localised metastases. Radiation therapy is combined with chemotherapy in locally extensive stages devoid of surgical procedure.
Thanks to its technical radiotherapy platform, Gustave Roussy offers conformal radiotherapy to the vast majority of patients and, in some cases, breath-hold conformal radiotherapy. High-precision stereotactic radiotherapy is available for lesions of a certain size (Novalis® and Cyberknife radiotherapy machines). These treatments are the result of teamwork involving Gustave Roussy's expert clinicians, physicists, radiotherapy manipulators and dosimetrists.

Thermal ablation by interventional radiology

In some cases, small lung tumours can be destroyed by burning them with an electrode introduced through the skin (radiofrequency) or by cryotherapy (cold treatment). These interventional radiology techniques are guided by simultaneous imaging (CT scan, ultrasound, endoscopy), which provides in-depth views without resorting to conventional surgery. 
► More information about interventional radiology

Medicinal treatments

Conventional chemotherapy

Chemotherapy provides the basis for advanced lung cancer therapy. It is also used post-surgery when the tumour is larger than 4 cm and/or when some of the removed lymph nodes are pathological. 
The aim of chemotherapy is to prevent the proliferation of tumour cells. It is administered intravenously via a port or an implantable chamber placed under the skin. The duration and number of therapeutic sequences vary depending on the type of tumour and the patient's tolerance.

Targeted therapies

Targeted therapies are modern treatments that aim to destroy tumour cells by targeting specific tumour anomalies. These treatments can only be administered if the tumour presents certain molecular characteristics or anomalies. The most well-known mutations currently involve the EGFR, ALK and ROS1 genes. They are not common, affecting between 1 and 12% of patients, and tend to be found in non-smoking patients. Targeted therapies are administered alone and for a variable, often prolonged, period.

Immunotherapy

The purpose of immunotherapy is to stimulate the immune system in the fight against tumour cells. Indeed, tumour cells can hamper immune system activity by attaching themselves to an immune cell receptor. Immunotherapies are antibodies that prevent the action of tumour cells by blocking this receptor. These treatments are currently administered alone or in combination with conventional chemotherapies. Several studies are ongoing and their ranking in the therapeutic sequence will probably change.

Towards advanced therapy medicinal products for lung cancer

Depending on the characteristics and stage of the cancer, doctors can invite patients to participate in clinical trials. Patients can be referred to a clinical trial during treatment by their referring oncologist. Patients can therefore receive “standard” treatment or more innovative treatment as part of the clinical trial framework.
► View the ongoing clinical trials at Gustave Roussy

New techniques to analyse your cancer

The referring oncologist/chest specialist may recommend a fluid biopsy (blood sample) to test for a molecular anomaly likely to target your treatments more efficiently. The therapeutic strategy can be discussed at a multidisciplinary "molecular" meeting, if required.

Supportive care

In addition to medical care, supportive care is also offered to Gustave Roussy patients in line with their wishes and needs (psychological, nutritional and pain management, adapted physical activities, etc.).

International Thoracic Cancer Center Staff

Gustave Roussy

• Fabrice Barlesi, General Director of Gustave Roussy, medical oncologist
• David Planchard, thoracic oncologist, chairman of the thoracic cancer commitee of Gustave Roussy and president of the International Thoracic Cancer Center
• Benjamin Besse, medical oncologist, director of clinical research at Gustave Roussy
• Mihaela Aldea, medical oncologist
• Angela Botticella, radiotherapist
• Cécile Le Péchoux, radiotherapist
• Antonin Levy, radiotherapist
• Aurélien Marabelle, immuno-oncologist
• Ines Kasraoui, radiologist
• Charles Roux, surgical radiologist
• Jose Carlos Benitez Montanez, medical oncologist
• Camilo Garzia, nuclear physician 
• Santiago Ponce, medical oncologist
• Pernelle Lavaud, medical oncologist

Hôpital Marie-Lannelongue

• Antoine Agathon, director of Research, Innovation and Education
• Caroline Caramella, radiologist
• Adrian Crutu, pneumologist
• Gaëlle Dauriat, pneumologist
• Dominique Fabre, thoracic and cardiovascular surgeon
• Elie Fadel, medical director and director of the thoracic, vascular and transplants unit
• Séverine Feuillet, pneumologist
• Valentina Florea, pneumologist
• Antoine Girault, thoracic and cardiovascular surgeon
• Amir Hanna, pneumologist
• Thierry Le Chevalier, oncologist
• Jérôme Le Pavec, pneumologist
• Jean-Baptiste Menager, thoracic and cardiovascular surgeon
• Olaf Mercier, chirurgien thoracique et cardiovasculaire
• Delphine Mitilian, thoracic and cardiovascular surgeon
• Sacha Mussot, thoracic and cardiovascular surgeon
• Pauline Pradere, pneumologist
• Vincent Thomas de Montpreville, anatomocytopathologist

Hôpital Paris Saint-Joseph

• Charles Naltet, medical oncologist
• Valéria Marini, radiologist
• Caroline Touloupas, surgical radiologist
• Marie de Torcy, pneumo-oncologist
• Stéphane Jouveshomme, pneumo-oncologist
• Flore Bintein, pneumo-oncologist
• Julien Adam, anatomopathologist