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the outer parts of the lungs, so tumors in these areas often need to be biopsied by passing a needle through the skin. This newer approach can help a doctor use a bronchoscope to biopsy a tumor in the outer part of the lung. First, CT scans are used to create a virtual bronchoscopy. The abnormal area is identified, and a computer helps guide a bronchoscope to the area so that it can be biopsied. The bronchoscope used has some special attachments that allow it to reach further than a regular bronchoscope. This takes special equipment and training, and it is not widely available at this time. Treatment Surgery Doctors now use video-assisted thoracic surgery (VATS) to treat some small lung tumors. This procedure lets doctors remove parts of the lung through smaller incisions, which can mean shorter hospital stays and less pain for patients. Doctors are now studying if VATS can be used for larger lung tumors. In a newer approach to this type of operation, the surgeon sits at a specially designed control panel inside the operating room to maneuver long surgical instruments using robotic arms. This approach, known as robotic-assisted surgery, is now being used in some larger cancer centers. It is not clear at this time if this type of surgery is better than current traditional surgery for lung cancer. Real-time tumor imaging Researchers are looking to use new imaging techniques, such as four-dimensional computed tomography (4DCT), to help improve treatment. In this technique, the CT machine scans the chest continuously for about 30 seconds. It shows where the tumor is in relation to other structures as a person breathes, as opposed to just giving a ‘snapshot’ of a point in time, like a standard CT does. To help doctors deliver radiation more precisely to a tumor, 4DCT can be used to determine exactly where the tumor is during each part of the breathing cycle. This technique might also be used to help show if a tumor is attached to or invading important structures in the chest, which could help doctors determine if a patient might be eligible for surgery. 11 American Cancer Society cancer.org | 1.800.227.2345 Targeted therapy drugs Researchers are learning more about the inner workings of lung cancer cells that control their growth and spread. This work had led to the development of new targeted therapy6drugs, many of which are already being used to treat NSCLC. Targeted drugs that are approved for use in other cancer types are now being studied in NSCLC that have a change in the RET gene. These drugs include sunitinib, sorafenib, vandetanib, and cabozantinib. Brain metastases: Brain metastases are a common problem in people with lung cancer and often result in worse outcomes. Whole brain radiation is the usual treatment and can have certain long-term side effects. For people with limited spread of lung cancer to the brain, newer radiation techniques, like SRS7 , allow for only the specific tumor to be treated with radiation while sparing the rest of the brain. This type of radiation has fewer side effects and is still effective in treating the cancer. A new drug, AZD3759, is being tested in early clinical trials and shows promising results in people with NSCLC with an EGFR gene change and spread to the brain. The drug seems to be able to cross the blood-brain barrier. Another investigational oral drug, epitinib, a kinase inhibitor, has also shown some encouraging results in treating brain metastases in NSCLC patients with the EGFR gene change. Maintenance therapy For people with advanced lung cancers who get chemotherapy, combinations of 2 chemo drugs (sometimes along with a targeted drug) are typically given for about 4 to 6 cycles. Some studies have found that with NSCLC cancers that have not worsened on treatment, continuing treatment with a single chemo drug such as pemetrexed or with a targeted drug beyond the 4 to 6 cycles may help some people live longer. This is known as maintenance therapy. A possible downside to this continued treatment is that people may not get a break from treatment side effects. Maintenance therapy is recommended more often now, but it is not an option for some people whose cancer is not under control or who are in poor health. Immune treatments Researchers are developing