Radiotherapy for non-small cell lung cancer

Radiotherapy treats cancer by using high-energy x-rays to destroy the cancer cells, while doing as little harm as possible to normal cells. The treatment is given in the hospital radiotherapy department. The number of treatments you have, and the length of time they take, will depend on the stage| of the cancer and the aim of treatment.

Radiotherapy is usually given by aiming high-energy x-rays at the lung from a radiotherapy machine. This is known as external beam radiotherapy. Sometimes a type of internal radiotherapy called endobronchial radiotherapy or brachytherapy may be used.

Why radiotherapy is given Back to top

Radical radiotherapy can be given with the aim of curing the cancer. This may be instead of surgery. There are different ways of having radical radiotherapy.

You may have treatment every week day with a rest at the weekend. The treatment will be given for 3–7 weeks.

Sometimes radical radiotherapy will be given using CHART| (Continuous Hyperfractionated Accelerated Radiotherapy). The dose of radiotherapy is divided so that more than one treatment, or fraction, is given each day. People having CHART are given treatment every day, including weekends, until the course is over. The course usually lasts 12 days.

Palliative radiotherapy may be used to control and relieve symptoms such as breathlessness, chest pain, cough and coughing up blood. Often only one or two treatments are given. Sometimes a higher dose of radiotherapy is given over two weeks if the doctor thinks this may be helpful. Treatment is given each weekday with a rest at the weekend.

How external radiotherapy is given Back to top

To make sure that the radiotherapy works as well as possible, it has to be carefully planned. Before you start your treatment you will have pictures taken with a special CT scanner| and measurements will be taken by the therapy radiographers. The information will be used to work out the details of your radiotherapy. Treatment planning is a very important part of radiotherapy, and it may take a couple of visits. The doctor who plans and supervises your treatment is known as a clinical oncologist.

Marks may be drawn on your skin to help the radiographer (who gives you your treatment), to position you accurately and to show where the rays are to be directed. It’s important not to wash or rub them off until the treatment is finished. Occasionally, tiny permanent marks (tattoos) are made on the skin in case further treatment is needed later. At the beginning of your radiotherapy you will be given instructions on how to look after your skin in the area to be treated.

Before each session of radiotherapy the radiographer will position you carefully on the couch, either sitting or lying, and make sure that you are comfortable. During your treatment you will be left alone in the room, but you will be able to talk to the radiographer who will be watching you. Radiotherapy is not painful and only takes a few minutes, but you do have to stay still while the treatment is being given.

How internal radiotherapy is given Back to top

This type of radiotherapy may be given when the tumour is blocking one of the airways and has made the lung collapse. It is a simple way of opening up the airway. If you have this type of radiotherapy, you usually need only one session of treatment.

A thin tube (catheter) will be temporarily put inside your lung using a bronchoscope|. Then a small piece of solid radioactive material (the source) will be placed inside this tube, next to the tumour.

The radiotherapy is delivered directly to the tumour and healthy tissue will only be slightly affected. The source is left in place for a few minutes to give the treatment. The source and catheter are then removed. The treatment can be repeated two or three times, depending on the dose of radiotherapy you need.

Side effects of radiotherapy to the chest Back to top

Radiotherapy can cause general side effects, such as tiredness. It can also cause chest pain or a few days of flu-like symptoms. You may notice that you develop a cough and produce more sputum (phlegm), which may have flecks of blood in it. This is quite normal. These side effects can be mild or more troublesome, depending on the strength of the radiotherapy dose and the length of your treatment. Your radiotherapist will be able to advise you about what to expect.

Problems with swallowing

After two to three weeks of treatment, the main problem you are likely to notice is difficulty in swallowing. This may be very uncomfortable. You may also have heartburn and indigestion. This happens because the radiotherapy can narrow your gullet (oesophagus). Tell your doctors if you have problems swallowing, as they can give you medicines to help. If you don’t feel like eating, or have problems with swallowing, you can replace meals with nutritious, high-calorie drinks. These are available from most chemists and can be prescribed by your GP.  Our section on diet| has some helpful hints on how to eat well when you are feeling ill.

Tiredness

Radiotherapy can make you feel tired|, so try to get as much rest as you can, especially if you have to travel a long way for treatment each day.

Skin care

Some people develop a skin reaction similar to sunburn. Pale skin may become red and sore or itchy; darker skin may develop a blue or black tinge. You will be given advice on how to look after your skin by the radiographer giving your treatment.

Hair loss

External radiotherapy will make your hair will fall out within the treatment area, including chest hair for men or head hair if you are given prophylactic cranial radiotherapy. The hair usually grows back, although occasionally the hair loss| is permanent.

All the side effects should disappear gradually once your treatment is over, but it’s important to tell your doctor if they continue.

Radiotherapy treatments for lung cancer do not make you radioactive. It is perfectly safe for you to be with other people, including children, throughout treatment.    

Long-term side effects

Very rarely radiotherapy for lung cancer can cause long-term side effects such as inflammation, or hardening and thickening (fibrosis) of the lungs. This can cause symptoms such as shortness of breath and a cough. The gullet (oesophagus) may also be affected and become narrower, making swallowing difficult. The bones in the chest area may become thinner and more brittle.

Long-term side effects are very rare, but it’s important that you are aware of them so that you can seek medical advice if you notice any symptoms.