Lung Cancer Treatment in Israel

Lung cancer remains one of the most challenging oncological tasks in modern medicine: in most patients, the disease progresses asymptomatically for a long time, and when symptoms appear — coughing with blood, unexplained shortness of breath, weight loss — the process has often already progressed to stage III–IV. Ichilov Clinic (Sourasky Medical Center) in Tel Aviv accepts patients suspected of lung cancer in a "one-stop shop" mode: within 3–5 working days, a complete review of the diagnosis is conducted, a repeat histological examination, molecular profiling of the tumor using NGS, PET-CT, and a multidisciplinary consultation involving a thoracic surgeon, oncologist, radiation therapist, pulmonologist, and pathomorphologist. Patients are offered treatment according to current NCCN and ESMO protocols — from robotic lobectomy in early stages to a combination of immunotherapy with chemotherapy and targeted drugs in advanced disease. This material details how the patient pathway is structured at Ichilov: from the first consultation to long-term follow-up after active treatment.

What is this disease

Lung cancer is a malignant tumor that develops from the epithelium of the bronchi, bronchioles, or alveoli. In clinical practice, it is divided into two fundamentally different groups, each with its own biology and treatment approaches.

Non-small cell lung cancer (NSCLC) accounts for about 80–85% of all cases. It includes three main histological subtypes: adenocarcinoma (more common in never-smokers, women, often peripheral localization), squamous cell carcinoma (more strongly associated with smoking, central localization), and large cell carcinoma. NSCLC is the primary target for targeted therapy — due to the extensive panel of "driver" mutations.

Small cell lung cancer (SCLC) — 15–20% of cases. This is an aggressive neuroendocrine tumor with a high doubling rate and early metastasis. It is almost always associated with smoking. At the time of diagnosis, most patients already have extensive disease.

Risk factors. The main one is smoking, including passive smoking; the risk increases with duration and intensity. Significant factors also include radon exposure in residential areas, asbestos, heavy metals (nickel, chromium, arsenic), diesel fuel combustion products, ionizing radiation, chronic obstructive pulmonary disease, family history, and HIV infection. In never-smokers, lung cancer more often has molecular drivers — EGFR mutations, ALK rearrangements, ROS1.

Symptoms. Persistent cough, changes in the nature of the habitual "smoker's cough", hemoptysis, shortness of breath, chest pain, recurrent pneumonia in the same area, hoarseness, Pancoast syndrome (shoulder and arm pain with apical tumors), superior vena cava syndrome, metastatic symptoms (bone pain, headaches, neurological disorders). Paraneoplastic syndromes — hypercalcemia, SIADH, Lambert-Eaton syndrome — are more common in SCLC.

Screening. International guidelines recommend annual low-dose computed tomography (LDCT) for individuals aged 50–80 with a smoking history of 20 pack-years, who currently smoke or quit less than 15 years ago. LDCT reliably reduces mortality from lung cancer — it is the only screening method with proven benefit. At Ichilov, LDCT is available as a standalone service and as part of a check-up for at-risk patients.

Diagnosis at Ichilov Clinic

The diagnostic pathway at the Sourasky Medical Center is structured to obtain a complete clinical stage-specific portrait of the tumor and begin treatment within 3–5 working days.

Review of existing studies. Slides and paraffin blocks from the patient's home clinic are reviewed by a pathomorphologist at Ichilov. Discrepancies between the primary and repeat histological conclusions are not uncommon — from clarifying the subtype of NSCLC to a complete change of diagnosis (for example, differentiating squamous cell carcinoma from a metastasis of head and neck cancer).

Laboratory base. Comprehensive blood analysis, biochemistry with LDH, calcium, sodium, coagulation profile, tumor markers (CEA, CYFRA 21-1, NSE, ProGRP in suspected SCLC), and if indicated — blood gases and external respiratory function (spirometry, DLCO) to assess operability.

Imaging. High-resolution chest CT with contrast, and for peripheral lesions — targeted thin-slice reconstruction. PET-CT with 18F-FDG is a mandatory standard for staging: it detects hidden lymphogenic and distant metastases, assesses the metabolic activity of the primary lesion. Brain MRI with contrast — for adenocarcinoma and SCLC is part of the standard protocol due to the high frequency of asymptomatic cerebral metastases.

Morphological verification. The method of tissue collection is chosen by the multidisciplinary team depending on the localization:

• EBUS-TBNA (endobronchial ultrasound-guided fine needle aspiration) — the gold standard for assessing mediastinal lymph nodes and central tumors. It allows targeted sampling from groups 2R/2L, 4R/4L, 7, 10, 11 under real-time ultrasound guidance.
• Robotic navigational bronchoscopy — for peripheral nodules inaccessible by conventional bronchoscopy. The robot guides the instrument through the smallest bronchioles to a nodule with a diameter of 8–10 mm with precision to a few millimeters.
• CT-guided transthoracic biopsy — for peripheral lesions inaccessible by bronchoscopy.
• Mediastinoscopy / VATS biopsy — if less invasive methods do not yield material.

Molecular profiling. In NSCLC (especially adenocarcinoma), extended NGS sequencing is mandatory to assess EGFR (including exon 20), ALK, ROS1, KRAS (including G12C), MET (exon 14 skipping, amplification), RET, BRAF V600E, HER2, NTRK, as well as PD-L1 (TPS). Additionally — TMB (tumor mutational burden) when considering immunotherapy. It is the molecular profile that determines the choice of first-line therapy in advanced stages and increasingly influences decisions in early-stage NSCLC (adjuvant osimertinib, alectinib).

Treatment Methods

The strategy depends on histology, molecular profile, TNM stage (8th edition), functional status, and patient preferences. The multidisciplinary consultation forms a personalized roadmap.

Surgery for early NSCLC (stages I–IIIA). The main radical method. At Ichilov, the following are performed:

• VATS lobectomy — video-assisted thoracoscopic resection of a lung lobe through 3–4 mini-incisions. Less pain, shorter hospitalization, faster return to normal life compared to open thoracotomy.
• RATS lobectomy — robotic lobectomy using the da Vinci system. The additional degree of freedom of the instruments allows for precise work in anatomically complex areas, carefully performing mediastinal lymphadenectomy.
• Segmentectomy — for peripheral tumors ≤ 2 cm in patients with limited pulmonary reserve; according to large studies, the results in selected patients are comparable to lobectomy.
• Pneumonectomy — for central tumors when lobectomy is not feasible; used less frequently due to bronchoplastic (sleeve) surgeries.
• Systematic mediastinal lymphadenectomy — a mandatory component for accurate staging and reducing the risk of local recurrence.

Stereotactic radiotherapy (SBRT). For patients with stage I NSCLC for whom surgery is contraindicated due to somatic status, SBRT (3–5 fractions of high dose) provides local control comparable to surgical treatment. Ichilov uses linear accelerators with breathing tracking and IGRT control for each fraction.

Chemoradiotherapy. For locally advanced unresectable NSCLC stage III — concurrent chemoradiotherapy followed by consolidation with durvalumab (in the absence of driver mutations). Standard chemotherapy regimens — cisplatin/etoposide or carboplatin/paclitaxel in parallel with 60–66 Gy.

Immunotherapy. A key breakthrough of the last decade. PD-1/PD-L1 checkpoint inhibitors — pembrolizumab, atezolizumab, nivolumab, durvalumab — are used in various scenarios: as monotherapy with high PD-L1 expression (TPS ≥ 50%), in combination with chemotherapy regardless of PD-L1, in neoadjuvant (before surgery) and adjuvant (after surgery) settings, as well as consolidation after chemoradiotherapy.

Targeted therapy for NSCLC. Used when the corresponding driver is identified:

• EGFR (common mutations del19, L858R): osimertinib — the drug of choice in the first line, including adjuvantly in IB–IIIA stages after surgery.
• ALK: alectinib, brigatinib, lorlatinib — second-generation ALK inhibitors with activity against CNS metastases.
• ROS1: crizotinib, entrectinib, repotrectinib.
• KRAS G12C: sotorasib, adagrasib — in the second line after progression.
• MET exon 14: capmatinib, tepotinib.
• RET: selpercatinib, pralsetinib.
• BRAF V600E: combination of dabrafenib and trametinib.
• HER2: trastuzumab deruxtecan (T-DXd) in HER2 mutations.

Treatment of SCLC. For limited stage — concurrent chemoradiotherapy (etoposide + cisplatin + thoracic radiotherapy), for extensive stage — the standard first-line treatment has become the combination of etoposide + carboplatin + atezolizumab (or durvalumab) with subsequent support from immunotherapy. In responding patients, prophylactic cranial irradiation (PCI) is considered to reduce the risk of cerebral metastases; an alternative is regular MRI monitoring.

Local therapy for metastases. Oligometastatic disease (up to 3–5 lesions) with controlled primary disease — an indication for aggressive local therapy: SBRT for metastases in the lungs, liver, adrenal glands, bones; cranial stereotactic radiosurgery (SRS) for small brain metastases instead of whole brain radiation.

Treatment Program — Stages

A typical sequence of actions for a patient arriving in Tel Aviv:

Day 1. Consultation with the coordinating oncologist. Examination, history taking, review of brought images and reports. Formulation of a preliminary hypothesis and ordering of missing studies.

Days 2–3. Instrumental diagnostics. PET-CT, brain MRI, if necessary — new biopsy (EBUS, navigational bronchoscopy, transthoracic). Tissue samples are immediately sent for NGS panel, with a turnaround time of 7–10 working days.

Days 3–5. Functional assessment. ECG, echocardiography, spirometry with DLCO, anesthesiologist consultation — if surgical treatment is planned.

Multidisciplinary consultation. A thoracic surgeon, medical oncologist, radiation therapist, pulmonologist, pathomorphologist, and radiologist discuss the case and formulate a written recommendation. The patient receives a detailed explanation of the plan and alternatives.

Active treatment. Depending on the plan — surgery with hospitalization for 3–7 days, outpatient chemotherapy/immunotherapy courses, SBRT (3–5 sessions), oral targeted therapy with regular monitoring.

Response assessment. Follow-up CT scans every 6–12 weeks during active therapy according to RECIST 1.1 criteria; PET-CT — as indicated.

Follow-up. After completing curative treatment — CT every 3–6 months for 2 years, then once every 6–12 months up to 5 years, taking into account the risks of recurrence and second lung cancer.

Prices and Costs

The final cost depends on the volume of diagnostics, stage, planned treatment, and duration of stay. Below are approximate ranges in US dollars, applicable for patients paying for treatment independently.

• Comprehensive diagnostic program (consultations, CT, PET-CT, brain MRI, laboratory tests, histology review) — from 6,000 to 9,500 USD.
• EBUS-TBNA with general anesthesia — from 3,500 to 5,500 USD.
• Robotic navigational bronchoscopy — from 5,000 to 8,000 USD.
• Extended NGS sequencing of the tumor — from 2,500 to 4,500 USD.
• VATS lobectomy with systematic lymphadenectomy and hospitalization — from 30,000 to 45,000 USD.
• RATS lobectomy — from 38,000 to 55,000 USD.
• Course of SBRT for the primary lesion (3–5 fractions) — from 15,000 to 22,000 USD.
• Chemotherapy cycle — from 2,500 to 4,500 USD (excluding drug costs).
• Immunotherapy (pembrolizumab, atezolizumab) — the cost of a vial ranges from 4,500 to 8,500 USD per administration; the total course amount is calculated individually.
• Targeted drugs (osimertinib, alectinib, sotorasib) — monthly course from 8,000 to 15,000 USD depending on the drug.

The final estimate is prepared after the consultation; the clinic provides a written commercial proposal with a breakdown of items.

Leading Doctors in the Field

The thoracic oncology program at Ichilov is led by a multidisciplinary team with many years of international experience. It includes:

• Head of the Thoracic Surgery Department — a specialist in VATS and RATS lobectomies, bronchoplastic (sleeve) surgeries, and mediastinal tumor surgery.
• Leading Medical Oncologist for Thoracic Tumors — oversees immunotherapy and targeted therapy protocols, participates in international clinical trials, determines the strategy for systemic treatment.
• Head of the Radiation Therapy Department — responsible for SBRT of primary lesions and oligometastases, concurrent chemoradiotherapy, PCI in SCLC.
• Leading Interventional Pulmonologist — performs EBUS-TBNA and robotic navigational bronchoscopy, ensuring rapid and accurate morphological verification.

A specific treating physician is assigned to the patient at the stage of program agreement: the international department considers the diagnosis, stage, and requested second opinion.

FAQ

In what language do consultations with doctors take place?

All key consultations are accompanied by a Russian-speaking coordinator or medical translator. Some doctors in the thoracic oncology department speak Russian. All reports are issued in English, and upon request — with professional medical translation into Russian.

What documents should be brought?

The most detailed discharge summary from the home clinic, all CT and PET studies on disks in DICOM format, slides and paraffin blocks from the primary biopsy, results of molecular tests, current blood tests. The more complete the package, the fewer duplicate studies and the lower the final cost.

How long will treatment take in Tel Aviv?

The diagnostic stage takes 3–5 working days. The active phase depends on the plan: surgical treatment — about 10–14 days including postoperative follow-up; SBRT course — 1.5–2 weeks; the first cycle of systemic therapy with patient education — 5–7 days. Many patients continue to receive targeted or immunotherapy at home, returning to Ichilov for follow-up visits every 3–6 months.

Is an advance payment required and how is treatment paid for?

An advance payment is made to initiate the program, covering the diagnostic block; subsequent payments are made upon approval of the plan by the consultation and signing of the estimate. The clinic accepts payment by bank transfer, and expensive drugs are purchased with a separate check with transparent documentation.

What is a multidisciplinary consultation?

This is an in-person meeting of key specialists discussing a specific case based on the collected data. A unified written recommendation is formed based on the results, indicating the stage, justification for the strategy, and alternative scenarios. The patient is provided with a copy of the protocol, which is convenient for subsequent discussion of the plan with family or for obtaining an independent opinion.

Is it possible to get a second opinion without coming to Israel?

Yes. The international department of Ichilov organizes a remote video consultation with a leading oncologist or thoracic surgeon. For this, it is sufficient to send the discharge summaries, images, and pathomorphological data in advance. The result is a written conclusion with recommendations for further strategy.

Does the clinic work with insurance companies?

Ichilov accepts patients from a number of international insurance companies and specialized assistance services, provided there is a guarantee letter. Russian-speaking patients paying for treatment independently receive detailed invoices in a format suitable for subsequent reimbursement under the health insurance policy.

How is follow-up organized after returning home?

The coordinator maintains contact via email and messengers, organizing online consultations if necessary. The patient sends the results of follow-up CT scans and tests from the home clinic; the oncologist at Ichilov provides a conclusion and, if necessary, adjusts therapy. All data is accumulated in a single electronic medical record.

How to obtain a treatment program

To receive an individual program for the diagnosis and treatment of lung cancer at Ichilov (Sourasky) in Tel Aviv, fill out the form on this page or write to the coordinator of the international department. Within 1 working day, a specialist will contact you, clarify the clinical situation, and request the necessary documents. After the initial assessment of the medical case by the leading oncologist, you will receive a preliminary examination plan, estimate, and proposal for arrival dates. A remote format is also possible — a telemedicine consultation for a second opinion based on the available images and histology. All data is transmitted through secure channels, medical confidentiality is maintained, and the patient pathway is structured to minimize the time to the start of treatment.