National Comprehensive Cancer Network

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Adult Oncology Services

Introduction

Since 1996, the adult oncology collaboration of Dana-Farber Cancer Institute, Brigham and Women's Hospital and Massachusetts General Hospital Cancer Center has enabled some of the world's leading specialists to coordinate research, training, and patient care. These Harvard Medical School-affiliated hospitals are members of Dana-Farber/Harvard Cancer Center, a National Cancer Institute-designated Comprehensive Cancer Center.

Patient care is provided at Dana-Farber/Brigham and Women's Cancer Center and Massachusetts General Hospital Cancer Center. At each site patients are offered the highest standard of care and innovative treatments.

Multidisciplinary Teams

At Dana-Farber/Brigham and Women's Cancer Center and Massachusetts General Hospital Cancer Center, treatment programs bring together a diverse team of sub-specialists and other healthcare professionals to work collaboratively on behalf of patients. This multidisciplinary approach to patient care offers several important advantages: It makes treatment more convenient and less stressful for patients and family members It allows patients and family members to have access to the entire care team, usually at the same time and in one place It greatly enhances quality by fostering close communication among everyone involved in the patient's care It facilitates collaboration among specialists, resulting in consistent treatment approaches that promise the best possible outcomes It provides patients with access to the latest promising therapies resulting from a close collaboration with basic scientists

General Information

New Patient Referrals	Dana-Farber/Brigham and Women's Cancer Center: 877.DFCI.BWH Massachusetts General Hospital Cancer Center: 877.789.6100
Physician to Physician Consults	Dana-Farber/Brigham and Women's Cancer Center: 617.724.9295 or DFBWHCancerCenter@partners.org Massachusetts General Hospital Cancer Center: 877.789.6100 or MGHCancerCenter@partners.org
Clinical Trial Information	Dana-Farber/Brigham and Women’s Cancer Center: 877.DFCI.BWH Massachusetts General Hospital Cancer Center:877.789.6100
Location	Boston, Massachusetts
Facility	Patient care is offered at two locations: Dana-Farber/Brigham and Women's Cancer Center Massachusetts General Hospital Cancer Center
Travel Assistance	New patient coordinators at each site of care are available to help patients coordinate their travel plans.
Lodging	New patient coordinators at each site of care will advise patients and their families on lodging options in the area.

Treatment

Treatment Center	Description
Breast	The breast programs offer multidisciplinary, comprehensive, individualized care for women with confirmed breast cancer, pre-malignant or and suspected conditions. Services include evaluation and diagnosis; the latest treatments, including access to investigational therapies; long-term follow-up care; genetic counseling and risk assessment; reproductive medicine counseling; palliative care and pain management . The centers also offer educational programs and support groups, resource centers with cancer information, and boutiques with products for women with cancer. Experts in the Breast Oncology Center at Dana-Farber/Brigham and Women's Cancer Center offer highly advanced approaches to treatment, including breast conservation surgery, regional anesthesia, state-of-the-art preoperative planning, unique radiation positioning for precise delivery of treatment and protection of heart and lung tissue, and targeted medical therapies based on each patient’s specific type of breast cancer. The Center assesses all tumors for molecular markers that can guide therapy, including estrogen and progesterone receptor expression, and gene amplification of HER2.  Additional tests are performed, including tests for specific genetic mutations, to determine eligibility for clinical trials and as part of our clinical research program. Specialized programs in the Center including the Program for Young Women with Breast Cancer, among few in the country to address the unique medical and psychological needs of women 42 years of age and younger with breast cancer.
Endocrine	The endocrine treatment centers provide evaluation and therapy for individuals with benign and malignant tumors of the thyroid, parathyroid, or adrenal glands, as well as individuals with pancreatic islet cell tumors. Diagnostic evaluations include fine needle aspiration biopsies (thyroid) as well as radioisotope and other radiologic imaging techniques. In addition to conventional therapies, patients have access to investigational therapies.
Gastrointestinal	The gastrointestinal cancer treatment centers offer comprehensive care for patients with gastrointestinal cancers, including cancers of the colon, rectum, stomach, esophagus, pancreas, anus, bile duct (cholangiocarcinoma), liver, gallbladder, and small bowel, as well as carcinoid and islet cell malignancies. These centers provide the latest treatments, including investigational therapies, for gastrointestinal cancers that encompass the most recent advances in surgery, chemotherapy, and radiation therapy. These include intraoperative radiation therapy, radiofrequency treatment, percutaneous cryosurgery, pancreatic resections, endoscopic ultrasonography, endoscopic biliary stent placement. In addition, patients have access to genetic counseling, molecular diagnostic testing, and support services, including social work, nutrition counseling and educational and support groups. At the Massachusetts General Hospital Cancer Center, all metastatic colorectal adenocarcinomas patients’ tumor samples are tested for specific genetic mutations, helping to personalize cancer treatment. Several new cancer drugs are currently available or in development and target some of these mutations and pathways that cause cancer cells to proliferate. By targeting cancer gene mutations with these smart drugs, doctors may be able to eradicate malignant cells without using traditional treatments like chemotherapy and radiation, which have significant side effects. Specialists in the Gastrointestinal Cancer Treatment Center at Dana-Farber/Brigham and Women's Cancer Center have been leaders in the implementation of newer approaches to the treatment gastrointestinal cancers, including advanced image-guided ablation techniques, resection techniques for tumors previously considered inoperable, and targeted medical therapies, including groundbreaking trials that have changed the standard-of-care for patients with gastrointestinal stromal tumor (GIST). Specialists in the Center use techniques to identify mutations that may alter the effectiveness of a particular therapy and help guide personalized treatment for patients. All colorectal cancers, for example, are tested for KRAS and BRAF mutations, and therapy is tailored according to each patient’s genotype. In addition, all esophageal and gastric cancer patients are tested for Her2 amplification and therapy is tailored accordingly.
Genitourinary	Patients with genitourinary cancers—cancers of the prostate, bladder, kidney, penis, or testicles—have access to the latest diagnostic approaches and innovative treatments, including investigational therapies, at the genitourinary cancer treatment centers. In addition to diagnosis and evaluation, the centers offer a wide range of the latest surgical, radiologic, and medical treatments to patients with suspected or confirmed malignancies or recurrent disease. The centers offer the latest minimally invasive nerve- and organ-sparing surgical approaches; radioactive seed implant, conformal therapies and intra-operative radiation therapy; and the newest hormonal, chemotherapy, multimodality, and novel biologic approaches. High-risk screening, nutrition counseling, and access to support services are also available. At the Genitourinary Cancer Treatment Center at Dana-Farber/Brigham and Women’s Cancer Center, urologic surgeons are among few nationwide to comprehensively offer robotic techniques across genitourinary cancers, including prostate, kidney, and bladder cancers, and have completed 900 robotic procedures for genitourinary cancers as of early 2010. Radiation oncologists in the Center have developed techniques to minimize risk of any urinary incontinence and reduce symptoms in patients with prostate cancer undergoing brachytherapy. Medical oncologists in the Center are offering targeted therapies and developing individualized medical treatments for patients. Specialists in the Center have also led groundbreaking discoveries regarding the significance of PSA changes in determining prognosis and defining treatment for patients with prostate cancer. Researchers and clinicians in the Center are working together to identify specific characteristics of a patient’s cancer in order to develop personalized therapies that offer the best results for each patient.
Gynecology	The gynecologic programs offer comprehensive, multidisciplinary evaluation, treatment and follow-up of patients with suspected or proven pre-invasive or invasive gynecologic malignancies, including ovarian, endometrial, cervical, vulvar, vaginal and trophoblastic cancers. Minimally invasive robotic surgery for cervical, endometrial and uterine cancer is available at Dana-Farber/Brigham and Women's Cancer Center. Services include evaluation and diagnosis; the latest treatments, including access to investigational therapies; long-term follow-up care; genetic counseling and risk assessment; reproductive medicine counseling; palliative care and pain management . The centers also offer educational programs and support groups, resource centers with cancer information, and boutiques with products for women with cancer. In the Gynecologic Oncology Program at Dana-Farber/Brigham and Women’s Cancer Center, our specialists were the first to offer robotic hysterectomy in New England and are among few in the nation to offer 3D image-guided brachytherapy. The medical oncologists in the Program are evaluating novel, targeted therapies, and the Program’s gynecologic pathologists, among the largest group of its kind, have made many significant discoveries regarding the early development of gynecologic cancers. New, advanced ovarian, peritoneal, and fallopian tube cancers undergo genotyping to look for mutations in PIK3CA, BRAF and KRAS genes, useful in clinical decision making. These new ovarian cancers also are genotyped on a Sequenom research platform of 1100 mutations in 110 oncogenes.
Head and Neck	The head and neck treatment centers provide evaluation and treatment for patients with all types and stages of head and neck cancers, from the earliest lesions to the rarest, most challenging tumors. These include malignancies of the larynx, oral cavity, nasopharynx, pharynx, paranasal sinuses, thyroid, and salivary glands, as well as cutaneous (skin) malignancies and periorbital tumors. A major focus of the clinical and research program is an emphasis on integrated chemotherapy, radiotherapy, and surgery for the treatment of locally advanced disease to preserve organs and improve survival.
Hematologic Malignancies	Patients with hematologic malignancies such as leukemia, Hodgkin's and non-Hodgkin's lymphomas, AIDS-related malignancies, multiple myeloma, myelodysplasia, and myeloproliferative disorders, have access to the latest therapeutic approaches, including investigational treatments, through specialized treatment centers. At Massachusetts General Hospital Cancer Center, there are five individual centers dedicated to hematology, bone marrow transplant, leukemia, lymphoma and multiple myeloma. Available treatments include standard outpatient and intensive inpatient chemotherapy, high-dose myeloablative therapy with stem-cell support (autologous, allogeneic, or unrelated donor bone marrow transplantation), radiation therapy, and new immune-based treatments.
Hematology Benign	The hematology treatment centers provide evaluation and treatment for patients with all non-malignant (non-cancerous) disorders of the blood and bone marrow. These include disorders of red blood cells and iron metabolism; porphyria; disorders of white blood cells, platelets, and plasma cells; disorders of hemostasis and thrombosis; and problems related to anticoagulation. Patients have access to routine comprehensive care or investigational diagnostic and treatment approaches The hematology treatment centers have specialized services for patients with inherited diseases such as sickle cell disease, related hemoglobinopathies, and Gaucher's disease. Transfusion support services that offer episodic and routine blood product infusions and apheresis procedures are also available.
Melanoma and Cutaneous Oncology	The melanoma and cutaneous oncology treatment centers provide a range of services, including screening of high-risk individuals and investigational therapies, to patients with all types and stages of melanoma and non-melanoma skin cancers. These centers provide one-time consultation and second opinions; prevention and early-detection counseling; genetic counseling and risk assessment; screening of high-risk individuals; histopathologic diagnosis and review; and the latest treatments, including Mohs surgery, immunotherapy, photon radiosurgery, and stereotactic radiosurgery. Patients also have access to clinical trials, including investigations of new immunologic therapies. The Center for Cutaneous Oncology and the Melanoma Center at Dana-Farber/Brigham and Women’s Cancer Center offer highly specialized programs for patients with all forms of melanoma, T-and B-cell lymphomas, Merkel cell carcinomas, basal and squamous cell carcinomas, adnexal tumors, graft vs. host disease, and adverse dermatologic side effects of cancer treatment. Novel approaches include the development of melanoma vaccines using the patient’s own tumor, brachytherapy treatment for Merkel cell, squamous cell, and other skin cancers, and photopheresis for B-cell lymphoma and graft vs. host disease.
Neuro-Onc	The neuro-oncology treatment centers provide consultation; state-of-the-art diagnosis, advanced treatments, investigational therapies, and long-term follow-up care for patients with benign or malignant tumors of the central nervous system. Proton beam therapy is available at the Massachusetts General Hospital Cancer Center. Patients include individuals with primary tumors, such as gliomas (astrocytomas, glioblastomas, brain stem gliomas, ependymomas, or oligodendrogliomas), pituitary adenomas, medulloblastomas, meningiomas, schwannomas, craniopharyngiomas, germ cell tumors, and pineal region tumors, as well as those with tumors that are secondary (that have spread) and nervous system lymphomas. At the Center for Neuro-Oncology at Dana-Farber/Brigham and Women’s Cancer Center, our specialists have developed novel, functional brain mapping techniques to guide surgical treatment of brain tumors, while avoiding areas of the brain responsible for speech, motor skills, and memory. Newer medical approaches include targeted molecular drugs, inhibitors of brain tumor growth, novel chemotherapies, and new drug delivery strategies. Image-guided, frameless stereotactic radiosurgery and radiation therapy provide highly-conformal and precise delivery of radiation to the tumor, while avoiding the need for a head frame. Specialists in the Center routinely tests patients with glioblastoma for EGFR amplification and MGMT methylation status and anaplastic gliomas for 1p,19q and MGMT methylation status. They also are beginning to sequence some glioblastomas for common mutations using SnapShot.
Sarcoma	The sarcoma centers make up the largest program in New England for patients with soft tissue sarcomas and bone tumors and offer extensive expertise in the assessment and novel treatment of these rare malignancies. Services include evaluation, histopathological diagnosis and review, and radiologic investigation of tumors, as well as surgical approaches to sarcomas, multimodality approaches to soft tissue and bone sarcomas, treatment of disease that has recurred or spread, and novel soft-tissue and bone-reconstructive techniques for limb preservation. The Center for Sarcoma and Bone Oncology at Dana-Farber/Brigham and Women’s Cancer Center provides advanced and multidisciplinary surgical resection and were the first to investigate the use of CT-based navigation to intraoperatively guide surgical resection of pelvic bone sarcomas and other bone types. Specialists also offer limb salvage techniques designed to preserve and maximize limb function for even the most extensive tumors. Radiation oncologists in the Center offer image-guided, computer optimized high dose rate brachytherapy, and medical oncologists are offering targeted and immune-based therapies. Specialists in the Center also use advanced genotyping for KIT and PDGFRA in primary resected GIST, as well as advanced molecular diagnostics in diseases such as PVNS, DFSP, PVNS, ASPS, EWS, SYnovial sarcoma, PEComas, and others.
Thoracic	The thoracic cancer centers provide evaluation and the latest treatments for patients with all stages of thoracic (chest) cancers, including lung cancer, mesothelioma, and cancers of the esophagus, mediastinum (thymoma, mediastinal germ cell tumors, and neurogenic tumors), and trachea, as well as cancers that have spread to the chest. Using a multidisciplinary approach, these centers involve specialists in thoracic surgery, medical oncology, radiation oncology, and pulmonary medicine as well as healthcare professionals in respiratory and physical therapy, social work, nutrition, and pain and symptom management. In addition to offering the latest diagnostic and treatment options, including minimally invasive procedures and multimodality therapy, the program offers patients access to clinical trials offering novel approaches to treatment. At the Massachusetts General Hospital Cancer Center, all metastatic lung adenocarcinomas patients’ tumor samples are tested for specific genetic mutations, helping to personalize cancer treatment. Several new cancer drugs are currently available or in development and target some of these mutations and pathways that cause cancer cells to proliferate. By targeting cancer gene mutations with these smart drugs, doctors may be able to eradicate malignant cells without using traditional treatments like chemotherapy and radiation, which have significant side effects. Specialists in the Thoracic Oncology Program at Dana-Farber/Brigham and Women’s Cancer Center have been at the forefront of new developments for the treatment of thoracic cancers. Our surgeons developed revolutionary techniques to significantly extent the survival of patients with malignant pleural mesothelioma and perform 80 to 90 percent of lobectomies using minimally invasive video-assisted thoracoscopic surgery (VATS), offering patients a shorter length of stay, faster recovery, and less pain. Radiation oncologists in the Program use innovative and advanced techniques to improve outcomes for patients, including 4D CT treatment planning, 3D conformal radiation therapy, IMRT, and stereotactic radiosurgery. Medical oncologists in the Program are offering novel combinations of treatment approaches. In addition, the Program performs systematic testing on all patients with advanced NSCLC for EGFR mutations, KRAS mutations, HER2, BRAF, PIKC3A mutations, EML4-ALK translocations and have offer personalized approaches for these genomic changes. The Women’s Lung Cancer Program offers highly-specialized care for women with lung cancer.

Stem Cell Transplant Program

Bone marrow transplantation (BMT) has been performed by specialists at the Dana-Farber/Brigham and Women's Cancer Center for 30 years, making it one of the nation's oldest transplant programs. It is also one of the largest and busiest BMT units, with more than 4,000 transplants to their credit, and approximately 300 cases annually. All types of blood stem cell and marrow grafting are performed, including matched and mismatched transplants from family members or unrelated donors, cord blood transplants, autologous transplants, and identical twin transplantation. The physicians in this program have made major advances in graft-versus-host disease prevention and therapy and in graft-versus-leukemia.

Since 1993, the Bone Marrow Transplant Program at the Massachusetts General Hospital Cancer Center has been committed to developing leading-edge strategies for autologous and allogeneic bone marrow and peripheral blood stem cell transplantation. It has been particularly successful in HLA-mismatched transplant strategies and for patients with multiple myeloma and kidney failure, having performed the world's first successful simultaneous kidney and bone marrow transplants from a genetically matched, living donor.

Both programs participate in the International Bone Marrow Transplant Registry (IBMTR), are fully accredited with the National Marrow Donor Program (NMDP), are members of the Cancer and Leukemia Group B (CALGB), are accredited by the Foundation for the Accreditation of Cellular Therapy (FACT), and are charter members of the Blood and Marrow Transplantation Clinical Trials Network of the National Institutes of Health (NIH).

The transplantation units at both centers are specially designed facilities that include standard and enhanced HEPA-filtration, positive air flow pressure, and laminar air flow units. Patients receive world-class care by a team of specialists, including a medical oncologist, radiation oncologist, hematopathologist, infectious disease specialist, oral surgeon, nutritionist, and social worker. The programs at both sites of care have the advantage of being part of highly regarded general acute hospitals that are capable of addressing any complication or specific consultative need that might arise with stem cell patients. Patients and family members have access to support groups and educational programs; complementary therapies; and low-cost, short- and long-term housing.

Advanced Radiation Therapies at Dana-Farber/Brigham and Women's Cancer Center

The Department of Radiation Oncology at the Dana-Farber/Brigham and Women's Cancer Center offers patients a comprehensive approach to radiation therapy with a team of expert physicians, physicists, nurses and radiation therapists who develop individualized care plans as part of a multi-specialty approach to each form of cancer, while constantly advancing treatment modalities through laboratory, translational and clinical research.

Caring for thousands of patients each year, our expert radiation oncologists collaborate with other leading cancer specialists within the 13 renowned disease-specific teams of specialists at Dana-Farber/Brigham and Women’s Cancer Center to develop the best treatment plan for each patient.

In addition to traditional approaches, the Dana-Farber/Brigham and Women's team has led in the development of:

Image-guided Radiation Therapy

Radiation oncologists at Dana-Farber/Brigham and Women's Cancer Center use a range of imaging techniques, including magnetic resonance imaging (MRI), computed tomography (CT), and ultrasound to guide radiation treatment while minimizing risk of damaging normal surrounding tissues. Image-guided radiation therapy is used for many forms of cancer, including prostate, gynecologic, and breast cancers.

Image guidance also enables precise placement of radioactive sources used in brachytherapy treatment for cancer. Specialists at the Center are among few in the world to offer real-time, MR-guided radiation implant therapy for the treatment of prostate and gynecologic cancers.

Intensity-Modulated Radiation Therapy (IMRT)

Intensity-modulated radiation therapy provides precise, high-dose radiation treatment to optimize cancer treatment, while minimizing radiation exposure and damage to normal surrounding tissues. IMRT is used to treat a wide range of cancers, including the treatment of brain, head and neck, prostate and breast tumors.

Accelerated Partial Breast Irradiation

Offering an alternative to six weeks of standard external beam radiation treatment for select patients with breast cancer, brachytherapy specialists at the Center offer accelerated partial breast irradiation using the temporary insertion of radioactive sources to destroy cancer cells. This treatment is performed in the Center's high dose rate (HDR) brachytherapy suite, which features a CT scanner for image-guided seed placement.

Stereotactic Radiosurgery (SRS) and Stereotactic Radiation Therapy (SRT)

Specialists at the Center are providing image-guided, stereotactic radiosurgery and radiation therapy to deliver intense, highly focused and precisely targeted irradiation for better outcomes and quality-of-life for patients with malignant and benign brain tumors.

Image-guided Brachytherapy

Brachytherapy specialists at the Center offer both high dose rate (HDR) and low dose rate brachytherapy using 3-dimensional image-guided techniques for gynecologic and prostate cancers. HDR brachytherapy delivers a high dose of radiation therapy in a short period of time. The Center's dedicated brachytherapy suite is designed for safe and efficient delivery of brachytherapy treatment. The suite is equipped with a CT scanner for real-time, image-guided radioactive source placement.

4-Dimensional (4D) PET CT

4D PET-CT enhances the already powerful imaging technology of PET/CT by introducing the ability to do metabolic imaging and also evaluate tumor motion within a single session. A 4D imaging component can be added to either or both of the PET and CT portion of the imaging study and both imaging modalities are potentially enhanced by the addition of 4D.

Stereotactic Body Radiation Therapy (SBRT) for Liver Lesions

Patients with solitary liver metastases who are not candidates for surgery may benefit from SBRT to liver metastases. This treatment modifies the techniques and principles of intracranial stereotactic radiation therapy for treating areas outside of the brain. Using three to five high-dose fractions of radiation therapy, multiple highly conformal beams coupled with immobilization techniques are designed to deliver a high dose of radiation therapy to the tumor while minimizing the dose to the surrounding liver and other normal structures.

Stereotactic Spine Radiotherapy

Patients with primary and metastatic tumors involving the spinal may benefit from stereotactic spine radiotherapy. Stereotactic spine radiotherapy uses image guidance with robotic patient positioning at the time of treatment to accurately target tumor. This highly precise form of radiation treatment can deliver focused radiation therapy to tumors of the spine while minimizing dose to uninvolved spinal cord.

Advanced Radiation Therapies at Massachusetts General Hospital Cancer Center

The Massachusetts General Hospital Cancer Center has long been at the forefront of radiation therapy. The radiation oncologists coordinate patient care with their subspecialty counterparts in Surgical Oncology, Medical Oncology, Pathology and Diagnostic Radiology. Special equipment and facilities including the Francis H. Burr Proton Therapy CenterM., richly complement this sub specialization of medical talents. Our radiation oncologists work with clinical physicists to bring the latest technological developments from industry to our patients. Treatment plans are created using the most advanced computing and imaging techniques. Clinicians, Radiation Oncologists, and Physicists have access to a complete array of devices to carefully administer radiation to “target tissues” while minimizing radiation exposure to uninvolved tissue.

Proton Beam Therapy

As the site of the only proton beam therapy center in the New England, Massachusetts General Hospital Cancer Center offers cancer patients the most precise and advanced form treatment available. Protons have unique physical characteristics that enable their energy to be very precisely controlled to target the tumor while sparing healthy tissue. In addition, the dose of proton beams can be conformed to the tumor shape with the use of devices that are custom-made for each patient.

4-D CT Imaging

Organ motion is problematic when using radiation therapy to treat cancers such as lung and liver. Radiation oncologists and physicists at Massachusetts General Hospital Cancer Center developed sophisticated software technology that takes into account the movement of organs over time. Called 4-D CT imaging (the four dimensions being width, height, depth, and time), this technology provides clinicians with far more precise information on tumor motion with which to plan and administer radiation therapy.

Respiratory Gating

Respiratory gating is another technology developed by Massachusetts General Hospital Cancer Center's radiation physics team in collaboration with industry partners. In simple terms, respiratory gating means that the therapeutic beam from the linear accelerator is automatically synchronized with the tumor's motion and is turned off (or “gated”) when the tumor is not in the desired position, achieving better tumor control; having fewer complications; and using higher, potentially more effective, doses of radiation.

High-Dose Rate Brachytherapy

Another technology available to patients¬---primarily those with gynecologic cancers—is high-dose rate (HDR) brachytherapy. Innovative use of HDR brachytherapy at Massachusetts General Hospital Cancer Center includes treatment to skin and soft tissue cancers. HDR brachytherapy can be delivered on an outpatient basis, with each treatment taking only about 15-minutes. HDR brachytherapy uses a tiny, very highly radioactive source, called Iridium-192, which is housed in a lead-lined device called an afterloader. During treatment, the computer-controlled afterloader delivers the radiation source, which is on the tip of a flexible cable, via a tube or tubes that have been placed in the appropriate positions within the patient's body. With HDR brachytherapy, the radiation oncologist controls where the source is placed and for how long. This makes it possible to conform the doses precisely to the tumor.

Surgical Care at Dana-Farber/Brigham and Women's Cancer Center

Surgeons are an integral part of the solid organ oncology multi-specialty disease centers at Dana-Farber/Brigham and Women's Cancer Center. Consistently at the forefront of minimally invasive approaches to care, the surgical team has led in the development of:

Robotic Surgery

Surgeons specializing in robotic surgery at Dana-Farber/Brigham and Women's Cancer Center have performed more than 1,200 procedures using the da Vinci Surgical System® to provide highly-advanced, minimally invasive surgical treatment for prostate, kidney, bladder, cervical, endometrial, uterine, and other cancers. Gynecologic oncologists in the Gynecologic Oncology Program were the first in New England to perform robotic hysterectomy. Urologic surgeons at the Genitourinary Cancer Treatment Center are among few nationwide to comprehensively apply robotic techniques across genitourinary cancers, including prostate, kidney, and bladder cancers. Urologic robotic surgery procedures performed at the Center include prostatectomy, nephrectomy, and cystectomy. Robot-assisted surgery offers outstanding benefits for patients, including a dramatically reduced recovery time and significantly less pain and discomfort compared with open procedures. Cancer treatment and control using robotic-assisted techniques have been shown to be comparable to open surgical techniques.

Radiofrequency-assisted Liver Resection

Surgeons at Dana-Farber/Brigham and Women's Cancer Center were the first in the world to report laparoscopic radiofrequency-assisted liver resection (hepatectomy). Used in the treatment of liver tumors, hepatectomy with radiofrequency resection is designed to minimize bleeding – the most serious risk during liver surgery. During this procedure, a device that generates radiofrequency energy – or heat – is used to close blood vessels and minimize bleeding along the line that the surgeon cuts to remove the diseased portion of the liver.

Video-assisted Thoracoscopic Surgery (VATS)

Thoracic surgeons at Dana-Farber/Brigham and Women’s Cancer Center have extensive experience in minimally invasive video-assisted thoracoscopic surgery (VATS) – including lobectomy, esophagectomy, thymectomy, and resection of small, contained metastic tumors. They perform 80 to 90 percent of lobectomies using VATS, offering patients a shorter length of stay, faster recovery, and less pain.

Computer-aided Surgery and Limb Salvage Techniques

Surgeons in the Center for Sarcoma and Bone Oncology were the first to investigate the use of CT-based navigation to intraoperatively guide surgical resection of pelvic bone sarcomas and other bone tumor types. Complex techniques are also used to salvage limbs and preserve and maximize limb function for even the most extensive tumors.

Total Mesorectal Excision (TME)

Surgeons in the Center use specialized nerve- and sphincter-sparing techniques during this procedure to avoid permanent colostomy for patients with rectal cancer. Patients treated with this technique generally experience lower cancer recurrence, lower levels of incontinence and impotence, and better overall survival rates.

Extrapleural Pneumonectomy with Chemotherapy Lavage for Mesothelioma

Surgeons at Dana-Farber/Brigham and Women's Cancer Center have developed revolutionary surgical techniques for the treatment of patients with mesothelioma. During this innovative technique, Extrapleural pneumonectomy, used to remove disease portions of the lung, is combined with a heated chemotherapy lavage or wash to destroy remaining cancer cells. This treatment has added years onto the lives of patients with malignant pleural mesothelioma – a disease with a traditionally poor prognosis.

Photodynamic Therapy for Lung and Esophageal Cancers

Surgeons at Dana-Farber Brigham and Women's Cancer Center have developed a novel Photodynamic Therapy Program to treat and improve the quality-of-life for patients with lung, esophageal, and airway cancers. The technique uses laser light to activate a photosensitive drug retained in cancer cells to destroy these cells.

Image-guided Neurosurgery

Neurosurgeons at Dana-Farber/Brigham and Women's Cancer Center use advanced, image-guided techniques to provide minimally invasive treatment and improved quality-of-life for patients. Preoperative planning and intraoperative imaging techniques also enable specialists at the Center to identify and preserve eloquent areas of the brain responsible for key motor, language, and other functions. Specialists at Brigham and Women's Hospital pioneered in the design and production of the intraoperative magnetic resonance imaging (MRI) scanner for image-guided surgery, and, in 1994, neurosurgeons at Brigham and Women's Hospital were the first in the world to use this technology to perform a brain tumor craniotomy.

Radio-Guided Surgery for Thyroid Tumors

Endocrine specialists at Dana-Farber/Brigham and Women's Cancer Center have compiled most of the early experience with radio-guided surgery. This consists of injection of patients with a radioactive tracer that accumulates in the tumor to be removed. The tumor is then located in the body with a hand-held radiation counter called a gamma probe. This has been highly useful for islet cell and carcinoid tumors and can also be used in re-operative surgeries of the thyroid for locating recurrent cancer.

Surgical Care at Massachusetts General Hospital Cancer Center

Surgeons at Massachusetts General Hospital Cancer Center offer the highest degree of specialization and expertise. Published data has demonstrated that hospitals and surgeons with the highest volume and experience with specific operations, especially complex operations, have the best outcomes, including the lowest complication and death rates. Recognizing the relationship between frequency of performing an operation and the quality of outcomes, each surgeon focuses his or her clinical practice on the management of one or two diseases.

Patients with newly diagnosed cancers are evaluated by surgeons working in the context of a comprehensive multidisciplinary team. This provides patients with well-coordinated, state-of-the-art cancer staging and treatment planning.

Specialty surgical techniques at Massachusetts General Hospital Cancer Center include:

• Esophagectomy – Massachusetts General Hospital Cancer Center is a high-volume center, performing over 60 esophagectomies each year
• Minimally invasive video-assisted thorascopic surgery – Video-assisted lobectomy, pneumonectomy and esophagectomy can now be performed, offering an alternative treatment option to patients who cannot otherwise tolerate open surgery
• Chest and airway reconstruction – Our physicians have developed many of the techniques now utilized worldwide in performing airway operations
• Mediastinal tumors – Our physicians are very experienced in the surgical treatment and the multidisciplinary treatment of advanced thymic malignancies
• Fertility-sparing patients who want to preserve their reproductive capability
• Prophylactic surgeries for high-risk patients
• Whipple procedure – Massachusetts General Hospital Cancer Center is one of the largest referral center in the Northeast for this complex procedure, which offers the best outcomes for pancreatic cancer when performed by experienced surgeons
• Radiofrequency ablation of liver, lung, and kidney tumors
• Hyperthermic isolated liver perfusion for advanced liver tumors
• Hyperthermic isolated limb perfusion for melanoma
• Laparoscopic approaches and other minimally invasive surgical techniques that have benefited some patients with liver, pancreatic, prostate or brain cancer
• Intraoperative radiotherapy for advanced tumors
• Laryngeal nerve monitoring during thyroid surgery to minimize the risk of nerve injury
• Liver transplant for both end stage liver diseases and liver cancer
• Endoscopic cranial-base surgery for minimally invasive resection of skull-based nasal-sinus tumors.
• Stereotactic-guided biopsy and tumor resection, including frameless stereotaxy
• Organ- and skin-sparing techniques for breast, gastrointestinal, genitourinary and head and neck cancers
• Continence-sparing techniques for gastrointestinal and genitourinary cancers
• Radiosurgery and proton radiosurgery for gliomas, metastases, as well as benign lesions such as meingiomas, acoustic neuromas and pituitary adenomas
• Robot-assisted surgical procedures for gynecologic and prostate cancers

Integrative/Complementary Medicine

Dana-Farber/Brigham and Women's Cancer Center and Massachusetts General Hospital Cancer Center offer integrative/complementary therapy services to patients and their families. These therapies can help reduce stress and relieve symptoms and side effects such as pain and chemotherapy-related nausea. Clinicians within both sites of care are committed to advancing the knowledge of the effectiveness and outcomes of these therapies through peer-reviewed, evidence-based clinical research. Our clinicians are dedicated to integrating the practice of complementary therapies into traditional cancer treatments. Acupuncture, yoga, Reiki and massage are a few of the complementary therapies offered.

Late Effects Clinic

At Dana-Farber, the David B. Perini, Jr. Quality of Life Clinic has helped thousands of adult survivors of pediatric cancers to manage the long-term consequences of their disease. Each patient is examined by a clinician with expertise in the long-term care of cancer survivors. The patient may then see specialists in radiation oncology, gynecology, endocrinology, or other areas, depending on the patient's particular medical history and personal needs. Each patient also meets with a psychologist. At the end of the patient's visit, the clinic's healthcare providers have a conference to discuss recommendations for follow-up care. These recommendations are shared with both the patients and their primary care providers. For those who want to meet with other survivors of childhood cancers, a variety of support and educational programs are offered.

Cancer Risk and Prevention

At Dana-Farber/Brigham and Women's Cancer Center and Massachusetts General Hospital Cancer Center patients concerned about the risk of virtually any type of malignancy have access to a variety of confidential, individualized services. These services include personal cancer-risk assessment; genetic counseling and evaluation of family history; screening examinations and tests; design of an individualized program of monitoring; and strategies, including lifestyle modifications and cancer-prevention agents, to reduce cancer risk.

A genetic counselor and physician, as appropriate, provides the initial, in-depth evaluation, drawing on the expertise of other oncology and medical specialists. The clinics also conduct active programs of clinical research, providing patients with the opportunity to participate in a variety of investigational studies.

Support Services

Dana-Farber/Brigham and Women's Cancer Center and Massachusetts General Hospital Cancer Center offer a broad range of educational/support groups and programs to patients and families.

Offerings include:

• post bone marrow transplant support group
• lung cancer support group
• brain tumor support group
• newly diagnosed breast cancer support group
• lymphoma group
• gastrointestinal cancers support group
• prostate group for patients and partners
• gynecological cancers education/support seminar series
• caregivers support group

Other educational seminars and programs are offered with focus on creative arts, complementary therapies, nutrition, pain and symptom management, spirituality, body image, and other wellness topics.

A patient-to-patient matching program connects new patients with other patients who are trained to offer guidance and support. Specialized boutiques provide products and services to help patients address changes in appearance.

Social workers at both sites of care provide emotional support and counseling to patients, couples, and family members. They are available to help patients and families cope with concerns and anxieties that may arise during illness and treatment. Social workers also lead many of the support groups listed above which give patients and families a chance to gain support and learn how others cope with illness. Resource specialists can also help patients identify community-based resources to meet various needs, including transportation, housing, and support groups.

Supportive Care

The Pain and Palliative Care Programs specialize in the management of pain and other physical, emotional, social, and spiritual concerns that patients and their families face as they cope with a life-threatening illness. The teams are made up of specially trained physicians, nurses, social workers, pharmacists, chaplains, and administrative personnel who work collaboratively with the patient's oncology team to develop a suitable care plan.

The following medical and support services are available to help patients and their families:

• State-of-the-art techniques to help with pain and other symptoms such as fatigue, depression, anxiety, nausea, and shortness of breath
• Emotional and spiritual support for patients and their family members, including children
• Therapies such as relaxation, meditation, guided imagery, therapeutic touch, Reiki, and yoga
• Survivorship program, supporting patients from the point of diagnosis, the first year post-treatment, through five years and beyond
• A peer support program for patients, family members, partners and friends living with a cancer diangosis
  
• Advance-care planning to help make wishes, beliefs, and values about treatment and life-sustaining measures known to family members and health care providers. This includes help with health care proxies or living wills, decisions about disease treatment in advanced disease, and end-of-life care
• Bereavement support
• Referral for additional services and providers, such as pain specialists, psychiatrists, physical therapists, or community agencies

Hospice Service

Hospice care is available to provide comprehensive medical, social, and spiritual care for patients with terminal illnesses. When aggressive treatment is no longer appropriate, hospice care focuses on keeping the patient comfortable and free of pain.

Family-centered care is provided at home, in extended care facilities, and in hospitals in Boston and surrounding communities. The hospice team is made up of the patient's primary care physician, a registered nurse, a medical social worker, a home health aide, a pastoral counselor, and a volunteer. Services are based on identified needs and the wishes of the patient.

Nutrition Service

Registered dietitians at both sites of care help patients and their families make healthful food choices. Working with the other members of the health-care team, the dietitians tailor an eating plan to meet each patient's individual needs. In addition, the dietitians help patients manage changes in appetite and weight, deal with the side effects of treatment, and advise about foods that will help rebuild strength.

The Marjorie E. Korff Parenting At a Challenging Time (PACT) Program

This program provides individual support for cancer patients who have children in their lives. Working hand-in-hand with parents, PACT's child psychiatrists and child psychologists offer age-specific guidance for helping children cope with a parent's cancer

Cooperative Group Membership

Cooperative Group Membership List	ACRIN ACOSOG CALGB COG NSABP RTOG NABTT
Average Number of Adult Clinical Trials	Dana-Farber/Brigham and Women's Cancer Center and Massachusetts General Hospital Cancer Center activate more than 15 new cancer trials each month and has more than 460 active clinical trials underway..

Clinical and Research Efforts

Dana-Farber Cancer Institute, Brigham and Women's Hospital, and Massachusetts General Hospital Cancer Center have consolidated the prolific clinical research programs of its three institutions into a single, fully integrated program. Doing so has not only fostered a greater exchange of ideas, which is the lifeblood of research, but has also improved the efficiency and speed with which discoveries can make their way from the laboratory bench to the patient's bedside.

The high volume and diversity of cancer patients served by Dana-Farber/Brigham and Women's Cancer Center and Massachusetts General Hospital Cancer Center make it possible for physician-investigators to conduct a wide variety of clinical research designed to answer many critical questions. These include studies evaluating the toxicity and effectiveness of new anticancer drugs, as well as investigations comparing the effectiveness of a new agent to a standard therapy.

The thousands of patients enrolled in clinical research trials within the cancer center have access to promising new therapies and, at the same time, contribute to knowledge that may lead to better treatments for all cancer patients, today and in the future.

Although innovative clinical trials are under way in virtually all aspects of cancer care, from studies of patients' quality of life to investigations of novel forms of therapy, areas of particular strength in the clinical research program include the exciting new fields of angiogenesis, clinical genetics, and vaccines.

Support for clinical research programs comes from the National Institutes of Health, national cooperative oncology groups, and private industry. Dana-Farber Cancer Institute, Brigham and Women's Hospital, and Massachusetts General Hospital Cancer Center receive more than $500 million in annual support for cancer research from the National Institutes of Health and private industry.

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