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Experts Weigh in on Innovations in Treatment of Lung Cancer


(Watch now: John DeRosimo, M.D. and Mark Richard Dylewski, M.D. Learn more about the services provided by the lung cancer surgeons, as well as their expertise in robotic surgery.)

Baptist Health South Florida’s Miami Cancer Institute lung cancer experts Rupesh Kotecha, M.D., chief of Radiosurgery and director of the CNS Metastasis Program, and Mark Dylewski, M.D., chief of general thoracic surgery, are featured presenters at the American Lung Association’s upcoming LUNG FORCE expo. We asked them for a sneak peek at their topics. To register for the program, go to LUNG FORCE Virtual Expo - American Lung Association | LUNG FORCE.


Rupesh Kotecha, M.D. – Topic at Lung Force Expo - Radiation Oncology Technology Considerations for Lung Cancer

Q: Radiation therapy is no longer one-size-fits-all for patients with lung cancer. What is new?

A: We are able to personalize the machine and treatment approach for each patient based on their individual patient factors as well as disease factors. One of the newest modalities is MR-guided radiotherapy delivery. This treatment is performed while the patient is shallow breathing or has a comfortable breath hold, therefore minimizing the risk of damage to the lung from radiotherapy. In addition, patients can actually watch this process during the treatment, which is quite unique and helps with patient engagement. Finally, for tumors close to critical structures, on this machine we can perform adaptive treatments. In other words, we can make a new radiation plan based on the patient’s anatomy of the day, accounting for differences in these critical structures.

Q: What are you most excited about in the future when it comes to treating lung cancer?

A: As screenings are expanded and adopted, I’m excited that patients will be diagnosed with early-stage lung cancer as opposed to finding locally advanced or metastatic disease. Moreover, increasing precision radiotherapy techniques continue to improve the therapeutic ratio. Also, newer advances in particle therapy are currently underway, for example proton therapy, which we are using in clinical trials at present.

Q: Why is teamwork so important when treating lung cancer?

A: Teamwork occurs at the multi-disciplinary level… medical oncology, thoracic surgery, pulmonary medicine, in addition to radiation oncology to decide the right treatment for each patient. At the radiation oncology-specific level, it also requires teamwork between dosimetrists, medical physicists and radiation therapists who deliver the treatments, not to mention schedulers, MAs and APPs.

Q: What if a radiation oncologist treating lung cancer doesn’t have access to the latest technology?

A: There are some ways to get around this, potentially increasing the number of treatments, decreasing the dose, or increasing the amount of normal lung treated with radiotherapy. This may also result in an escalation of care to a facility such as ours.


Mark Dylewski, M.D. – Topic at Lung Force Expo - Robotic Thoracic Surgery: Expanding the Role of Minimally Invasive Surgery for Treatment of Lung Cancer

Q: How is technology changing when it comes to minimally invasive techniques?

A: It has advanced to such a degree that even very complex surgery can be done through small, port-size incisions ? much more than in the past when we used traditional thoracoscopic instruments. You could accomplish a good number of these surgeries using that instrumentation, but with the advanced robotics we have today, almost everybody who presents with early stage lung cancer, and even many of those with more advanced cases, can be managed through a minimally invasive robotic approach.

Q: What do you see for the future with robotics?

A: The future is endless. AI and robotics are advancing so quickly that you see it in all aspects of your life. In terms of lung cancer surgery, the instrumentation is one factor, but the other piece of it is that the systems are augmented in such a way that it teaches surgeons how to adapt the technology into their practice. This is particularly important for young surgeons, who can now train on the robot and essentially do a resection of the lung by simulating it on a computer, rather than learning on a patient.

Q: Do all patients have access to the latest robotic technology?

A: Most facilities today have a robot, but there are still some access problems because the technology is expensive. The costs are continuing to come down, though, as competitors come to the market. And even though the technology is costly, it’s been shown that robotic surgery can be done for less cost to the healthcare system than traditional surgery. Of course, the advantage to patients is also significant, with fewer complications, shorter length of hospital stay and better recovery times.

Q: What do you advise patients to do when given the news that they have lung cancer?

A: Any time a patient is given a diagnosis of cancer or another complex illness, I say do not settle for one opinion. By getting two or three opinions, you will make the most informed decision and reassure yourself that you have the best healthcare plan in place.


Both physicians reiterated the importance of involvement with the American Lung Association, building awareness and educating the community on lung health and helping bring the latest advances to physicians around the nation. LUNG FORCE Virtual Expo - American Lung Association | LUNG FORCE

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