Radiotherapy for lung cancer

Radiotherapy is one of the main treatments for lung cancer. You often have it with other treatments. For example, radiotherapy for lung cancer might be given at the same time as chemotherapy. This is called chemoradiation.

Radiotherapy uses high-energy rays to destroy cancer cells. It destroys cancer cells in the area of the body where you have it, while doing as little harm as possible to normal cells.

Radiotherapy is given from a machine that delivers radiotherapy to the cancer. This is sometimes called external beam radiotherapy.

Before you start treatment, your radiotherapy needs to be planned. This makes sure the radiotherapy is aimed precisely at the cancer and causes the least possible damage to healthy tissue.

Your first planning visit usually takes 30 to 60 minutes or sometimes longer. You might need more than 1 hospital appointment. Your radiotherapy team will tell you what to expect and let you know if there is anything you need to prepare.

Before the planning visit, some people may need to have a mould made. This is a light plastic mesh shaped to your chest and shoulders. It fastens to the couch and keeps you still during your treatment. A technician or radiographer usually makes it in the radiotherapy department.

You usually have a planning CT scan of the chest. This helps your radiotherapy team to work out the precise dose and area of your treatment.

During the scan you lie still on a hard couch. It is important to tell the radiographers if you feel uncomfortable. Once you are in position and comfortable, the radiographers record the details of your position. You will need to be able to lie in the same position for all your radiotherapy sessions.

The radiographers might talk to you about using a breathing technique. This is not suitable for everyone and is not always done at the planning CT scan. It involves holding your breath for short periods of time to help keep your lungs still. You will be asked to use this technique when you have your radiotherapy treatments.

You might have some small permanent markings made on your skin. The marks are about the size of a pinpoint. They help the radiographers make sure you are in the correct position for each session of radiotherapy. Usually, tiny permanent markings are made in the same way as a tattoo.

The marks will only be made with your permission. If you are worried about them, talk to your radiographer.

Some people have standard radiotherapy. This usually means having treatment once a day, Monday to Friday for 4 to 7 weeks, with a break at the weekend.

But there are also some specialised ways of having lung radiotherapy for non-small cell lung cancer (NSCLC).

SABR is a specialised type of radiotherapy. It may be used to try to cure early lung cancer (stage 1 to 2).

You might have SABR if you cannot have lung surgery or do not want surgery. SABR is not available at every hospital, so you might have to travel to have it.

The radiotherapy team use scans, specialist machinery and complex planning to target the radiotherapy beams very precisely. This gives a very high dose of radiotherapy to small cancers, and only a low dose to healthy tissue surrounding it. This helps to reduce side effects.

You have fewer treatments over a shorter period. You might have SABR as 3, 5 or 8 treatments usually given every other day. Your doctor or radiographer will explain how many sessions you need over how many days.

SABR might also be used to treat some lung cancers that have spread to other parts of the body.

If you have stage 3 NSCLC lung cancer and are not having chemoradiation you might have continuous hyper-fractionated accelerated radiotherapy. This is sometimes called CHART.

You have radiotherapy 3 times a day including weekends, for 12 days. Each treatment must be at least 6 hours apart.

CHART is not available at every hospital, so you may have to travel to have it. You usually have to stay in the hospital or somewhere nearby during treatment.

Chemoradiation is when chemotherapy and radiotherapy are given at the same time. It is sometimes called concurrent chemoradiation.

Chemoradiation can make treatment more effective. But you usually have more side effects, so you need to be well enough to cope with these.

Some people have chemotherapy before or after radiation. This is called sequential chemoradiation. You might have this because it would be too difficult to cope with both treatments at the same time.

You may get some side effects over the course of your treatment. Your cancer doctor, specialist nurse or radiographer will explain the side effects so you know what to expect.

Always tell them about any side effects you have. There are often things they can do to help. They will also give you advice on how you can manage side effects.

If you have chemoradiation this might make the side effects worse.

Side effects might get worse after radiotherapy finishes. It can take 1 or 2 weeks after treatment before side effects start getting better. After this, most side effects usually slowly go away.

We have more information about the side effects of radiotherapy.

Radiotherapy can cause inflammation in the gullet (oesophagus). You may have:

• difficulty swallowing or pain when you swallow
• indigestion or heartburn.

These side effects usually happen towards the end of treatment and continue for a few weeks after it finishes. Your doctor can prescribe liquid medicines including pain killers to help reduce the symptoms.

To make swallowing easier, you could try these things:

• Avoid foods that are crunchy or hard to swallow.
• Avoid spicy, hot or very cold foods.
• Avoid citrus fruits like oranges, lemons or grapefruit, or juices.
• Eat softer foods or cut food into small pieces and add sauces or gravy.
• Take painkillers 30 minutes before you eat.
• Eat small meals more often instead of 3 meals a day.
• Drink plenty of fluids – use a straw if it is easier.
• Try not to smoke or drink alcohol – this can make your side effects worse.

If you have difficulty eating, you may meet with a dietitian. They can give you nutritious, high-calorie drinks. You can get these from most chemists, or your GP can prescribe them.

If you are not able to eat or drink enough, your doctor or dietitian might suggest you have tube feeding to maintain your weight. You have a thin tube that goes through the nose into the throat through which you have fluids and nutrition. This is not often necessary and is only needed until your side effects improve.

Radiotherapy often makes people feel tired. This can build up over your treatment. If you are having other treatments, such as surgery or chemotherapy, you may feel more tired.

It can help to:

• pace yourself and get plenty of rest
• do some light exercise, such as short walks – this will give you more energy.

Sometimes tiredness can continue for weeks or months after treatment finishes. If it does not get better, tell your doctor or nurse.

The skin in the treated area may get dry and itchy. If you have white skin this area might become red. If you have black or brown skin this area might become darker than the surrounding skin.

The radiographers will advise you on how to look after your skin. If it becomes sore, your doctor can prescribe cream to help. It can help to:

• wear loose-fitting clothes made from natural fibres such as cotton
• wash your skin gently with soap and water, gently pat dry and avoid rubbing
• use your usual moisturiser or ask the radiographer for advice
• use your regular deodorant unless the area gets irritated.

When you finish radiotherapy, you should protect the skin in the treated area from direct sunlight. Once any skin reaction has disappeared, use a suncream with a high SPF of 50.

You may find your breathing gets worse during radiotherapy and for a few weeks or months after it finishes. You may also get a dry cough. This is because radiotherapy can cause inflammation in the area of the lung being treated. This is called pneumonitis which can be serious.

It is important to contact your cancer team if:

• you have these symptoms
• these symptoms get worse.

They may prescribe steroids to help improve your symptoms. Pneumonitis can happen during radiotherapy or within a few weeks of it finishing.

Hair loss only happens in the treatment area. Men may lose hair on their chest, but it usually grows back. Occasionally hair loss is permanent.