Center for Thoracic Cancers

The Center for Thoracic Cancers at Smilow Cancer Hospital and Yale Cancer is a multidisciplinary program dedicated to providing cutting-edge evaluation and treatment to patients with thoracic malignancies in an efficient and coordinated manner.

Through the Center, patients have access to nationally recognized expert clinicians, who deliver an organized, collaborative approach to cancer care, and the latest technologies and treatments. Patients also benefit from newly available cancer therapies resulting from scientific insights gained in Yale laboratories and from other comprehensive cancer centers in the United States.

The Center coordinates and integrates the diagnosis, evaluation, and treatment of patients diagnosed with a thoracic malignancy, including lung cancer, thymic cancers, mesothelioma, or chest wall tumors. They also coordinate the surgical care of patients with esophageal cancer. Specialties include medical oncology, radiation oncology, thoracic surgery, pulmonary medicine, interventional oncology, pulmonary intervention, pathology, diagnostic imaging, and nursing. Collaboration with the Smilow Cancer Hospital Lung Cancer Screening Program has proven to be a critical tool in providing patients at risk with individualized, evidence-based screening, and helping to detect these cancers earlier.

Any patient cared for by one of our physicians benefits from the collective expertise of the entire Center’s physicians because of the team approach to care. Patients also benefit from a comprehensive program to help with the physical, emotional, and psychological issues that are part of effectively confronting cancer. Finally, because cutting-edge care is at times complex, patients also benefit greatly from the involvement of the team’s care coordinators, who make management of even the most detailed multidisciplinary treatment plan less complicated, which ensures that all of our patients are offered state-of-the-art care in all aspects.

Our medical oncologists are nationally recognized for their leadership and expertise in lung cancer treatment and research and are dedicated to offering personalized treatment options. Biomarker testing is often performed on the tumor to look for specific mutations that can be targeted by medication. There are currently FDA approved lung cancer treatments for tumors showing abnormalities in EGFR, KRAS, ALK, ROS1, BRAF V600E, MET, RET and NTRK genes.

Recent studies conducted at Yale have led to FDA approval of drugs for the treatment of lung cancer, such as the immunotherapy drug Tecentriq (atezolizumab), which has been proven to improve patient survival for newly diagnosed NSCLC. This drug is designed to block PD-L1, a protein that was discovered by scientists at Yale and has been instrumental in improving survival for lung cancer patients. Another FDA approved drug stemmed from research including Yale Cancer Center and Smilow Cancer Hospital researchers, osimertinib was approved for the treatment of adults with early-stage NSCLC with EGFR gene mutations.

Many patients in need of surgery are referred for a minimally invasive surgery known as a video-assisted thoracoscopic surgery (VATS), which is done through several small incisions, versus a major chest incision, and requires no rib spreading. Most lung cancer patients in need of surgery at Smilow Cancer Hospital are scheduled for a VATS procedure. VATS for lung cancer is only available in a small minority of hospitals in the U.S.

The da Vinci Robotic System is also available and provides patients with a less invasive surgical option, quicker recovery time, and decreased side effects. Our thoracic surgeons are extremely experienced using this technology to perform lobectomies for the treatment of lung cancer. Together, they perform the most robotic lung procedures in Connecticut. Smilow Cancer Hospital’s robotic technology, the da Vinci Xi, is the most advanced robotic platform available.

Smaller incisions, greater surgical precision, less pain for the patient, and a quicker return to normal activity, are just some of the benefits this technology allows for. Yale was one of the earliest institutions in the country to provide robotically assisted thoracic surgery for lung cancer. Your thoracic surgeon will discuss the surgical options available to you, and the benefits of each option.

The Center for Thoracic Cancers provides access to highly technically advanced radiation therapy treatment planning. A non-invasive technique, stereotactic body radiotherapy (SBRT) provides high doses of radiation with a high level of accuracy to lung cancer tumors. This precise treatment also results in less radiation delivered to surrounding tissue and fewer side effects.

Available to some patients who are not able to (or don’t wish to) undergo surgery, radiosurgery requires an array of specialized equipment and a well-trained staff of physicists, dosimetrists, and therapists. Radiation treatment is available to our patients at Smilow Cancer Hospital and conveniently at our Smilow Cancer Hospital Care Centers throughout Connecticut.

Our pulmonary medicine experts provide seamless care for patients from lung cancer screening and diagnosis through survivorship care. The Pulmonary Intervention Program (PIP) is a joint program between pulmonary/critical care medicine and thoracic surgery at Smilow Cancer Hospital. This collaboration combines advanced, state-of-the-art technology with physicians dedicated to the evaluation and treatment of patients with lung diseases. Our Pulmonary and Critical Care Medicine services are nationally and internationally recognized for providing advanced care for patients.

The following minimally invasive procedures are some highlights of the program:

• Peripheral endobronchial ultrasound (EBUS): Smilow Cancer Hospital is one of only a few hospitals in the state with this technology. This technology improves diagnostic sensitivity for lung nodules, masses or infiltrates, compared to bronchoscopy without ultrasound-guidance. Our physicians have the most experience in the state with EBUS and provide the greatest diagnostic accuracy possible.
• Electromagnetic navigation: an innovative procedure using electromagnetic technology that allows for better access to obtain tissue samples of lung masses. Smilow Cancer Hospital is the only hospital in the state of Connecticut offering this “GPS-like” bronchoscopic guidance through the lungs to nodules or masses in need of diagnosis.
• Confocal microscopy: physicians at Yale are among the first in the world to use and research this endomicroscopic system that enables visualization of microscopic cells in the lung.
• Whole Lung Lavage: PIP physicians are trained to treat patients with pulmonary alveolar proteinosis (PAP) through this and other techniques.

The Smilow Interventional Oncology Program offers cutting edge specialized services supporting all disciplines at Smilow Cancer Hospital. For the care of patients with thoracic malignancies, a team of dedicated and committed professionals with the highest level of expertise offer image-guided therapies, among other services. These minimally invasive therapies can be used either as primary or adjuvant treatments, and contribute to care that is truly multidisciplinary at Smilow Cancer Hospital. The program complements medical, surgical, and radiation oncology to provide optimal patient care.

In partnership with the Yale Thoracic Pathology Service, patient tissue obtained from the thorax, including lungs, trachea, and chest wall, are carefully reviewed. The Service includes evaluation of prognostic features relative to tumor immunotherapy (PD-L1 expression levels), and team members have extensive experience in diagnosing and classifying the full range of histopathology of lung disease, which is vital when making an accurate diagnosis that ultimately directs treatment planning. In this highly specialized area, our pathology team utilizes stateof- the-art techniques and approaches to provide diagnostic and prognostic pathology reports that are critical for the care of our patients. Characteristic mutations can be used as markers for the detection of very small numbers of tumor cells to increase the sensitivity and accuracy of pathologic diagnosis.

Smilow Cancer Hospital places great emphasis on taking care of all our patients’ needs with the best medical care available and a network of supportive care services. Advanced practice nurses with dedicated knowledge and skills related to the treatment of esophageal and lung cancers are available to care for patients through the continuum of their illness. Patients and their families are also provided with access to social workers to ensure psychosocial support during their treatment.

Additional resources for our patients and/or families include nutritional counseling, physical therapy, art therapy, and pastoral support. The Tobacco Treatment Program at Smilow Cancer Hospital operates on the principles of the U.S. Public Health Service Clinical Practice Guidelines and aims to help patients quit smoking by combining counseling and drug treatment. The program is available for patients being treated at any Smilow location. The Smilow Multidisciplinary Pain Program, in collaboration with other services such as Palliative Care, provides integrative pain medicine for patients who su er from pain as a result of their cancer treatments including radiation, chemotherapy, surgery, and pain caused by the disease itself.