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 is used.

Why radiotherapy is used Back to top

Radiotherapy can be given with the aim of curing the cancer (radical radiotherapy). This may be used instead of surgery. There are different ways of having radical radiotherapy. You may have treatment every weekday with a rest at the weekend. The treatment will be given for 3–7 weeks.

Alternatively, radical radiotherapy can be given using more than one treatment – or fraction – each day. This is called hyperfractionation. As more than one treatment is given each day, the length of the course of treatment will usually be shorter than with once-daily treatments. One type of hyperfractionated radiotherapy that gives three treatments a day continuously is called CHART |(Continuous Hyperfractionated Accelerated Radiotherapy).

Palliative radiotherapy may be used to control symptoms. 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'll have pictures taken with a special CT scanner| and measurements taken by the 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're comfortable.

During your treatment you'll 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's 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 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 2–3 weeks of treatment, the main problem you're likely to notice is difficulty swallowing. This may be very uncomfortable. You may also have heartburn and indigestion. This happens because the radiotherapy can cause inflammation in 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 (fatigue)

Try to get as much rest as you can, especially if you have to travel a long way for treatment. We have tips on coping with fatigue|.

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. Your radiographer will give you advice on how to look after your skin.

Hair loss

This will only happen within the treatment area, including chest hair for men. Your hair usually grows back, although occasionally 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.