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.
When radiotherapy is used
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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 once-daily treatments.
One type of hyperfractionated radiotherapy that gives three treatments a day is called Continuous Hyperfractionated Accelerated Radiotherapy (CHART). This type of treatment is not widely available, and you may have to travel to a different hospital if your doctor thinks this treatment is suitable for you.
Palliative radiotherapy may be used to control symptoms. Fewer treatments are given and they usually have fewer side effects.
How external radiotherapy is given
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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 CT scanner and measurements taken by the radiographers. This 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 position you accurately and set where the treatment will be delivered. It’s important not to wash or rub them off until the treatment is finished.
Sometimes tiny, permanent marks (tattoos) are made on the skin. At the beginning of your radiotherapy, you’ll 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 you're comfortable.
During your treatment you will be left alone in the room, but you'll 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.
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Stereotactic radiotherapy (SRT) is also known as stereotactic body radiation therapy (SBRT). It’s a new treatment that uses scans and specialist machinery to precisely target radiotherapy to treat small cancers. SBRT can be used to treat small primary and secondary lung cancers.
SRT/SBRT may be an alternative to surgery for people who can’t have surgery, or where the tumour is in a difficult area to operate on. It’s only suitable for some people. SRT is usually given over a shorter period of time than standard external radiotherapy.
Currently, this treatment is not widely available in the UK and you may be referred to a specialist hospital if your doctor thinks it is a suitable treatment for you.
How internal radiotherapy is given
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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’ll usually have only one session of treatment.
A thin tube (catheter) will be temporarily put inside your lung using a bronchoscope . A small piece of solid radioactive material (the source) will then 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
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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 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 doctors or radiographers will be able to tell you what to expect.
Problems with swallowing
Radiotherapy may cause the gullet (oesophagus) to become inflamed, which may make swallowing difficult and uncomfortable. You may also have heartburn and indigestion. Tell your doctors if you have problems swallowing, as they can give you drugs to help.
If you don’t feel like eating, or have problems with swallowing, you can supplement your food intake 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.
This is a common side effect and may continue for months after treatment is over. During treatment, you’ll need to rest more than usual, especially if you have to travel a long way for treatment each day. But it’s good to do gentle exercise, such as walking, when you feel able.
Once your treatment is over, gradually increase your activity and try to balance rest periods with exercise such as walking. This will help build up your energy levels. We have tips on coping with fatigue .
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.
This will only happen within the treatment area, so it’ll include chest hair for men or head hair if you are given prophylactic cranial radiotherapy. The hair usually grows back, although sometimes hair loss is permanent.
Any side effects should disappear gradually once your treatment is over, but it’s important to tell your doctor if they continue.
Radiotherapy treatment for lung cancer does not make you radioactive. It’s perfectly safe for you to be with other people, including children, throughout your treatment.
Long-term side effects
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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. These symptoms can take months, or even years to develop.
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.