Radiotherapy has been an effective treatment for lung cancer. It is the most common treatment for used for non-small cell lung cancers because in general, they are slow growing tumours.
Radiotherapy is a type of cancer treatment which uses high energy x-rays (radiation) to destroy cancer cells while avoiding normal cells. It is given in small individual doses (fractions) aimed precisely at the tumour over a specified period. This can range from a few days to as many as six and half weeks (up to 33 treatments).
Small cell lung cancer can also be treated with radiotherapy when chemotherapy is not suitable. Radiotherapy can be particularly helpful for treating lung cancer that has spread outside of the lung.
Radiotherapy is usually given from outside the chest (external radiotherapy) by directing x-rays at the area needing treatment. The machines that are most commonly used for this are called linear accelerators. However, radiotherapy can also be given by putting a small amount of radiation directly inside the lung (brachytherapy).
Radiotherapy doctors (radiotherapists) will know which treatment is best for the patient. The following information in this section is referring to external radiotherapy. Radiotherapy is only given in specialist cancer centres because the treatment is very specialised and expensive. This may involve long journeys to the nearest cancer centre, depending on where the patient lives.
What is the aim of radiotherapy treatment?
Radiotherapy can be used to treat lung cancer in several ways:
- Radical radiotherapy: The aim of radical radiotherapy is to shrink and control the growth of your tumour, with the intent of curing your cancer and prolonging your life.
- Palliative radiotherapy: This is designed to control the symptoms caused by your tumour and improve your quality of life. It may also prolong your life.
- Prophylactic Cranial Irradiation (PCI): This is designed to prevent or reduce the risk of tumours developing in your brain.
There are different ways of having radical radiotherapy. This includes:
- Conventional fractionated radiotherapy: This is given as daily treatments lasting for up to six weeks. The purpose of this treatment is to stop the growth of the cancer or even destroy it with a chance of cure.
- Hyperfractionated: This means radiotherapy is given in larger numbers of smaller doses (fractions) of treatment, usually given 2 or 3 times in one day.
- Hypofractionated: This means radiotherapy is given in larger doses (fractions) of treatment given once a day or less often over a shorter period of time.
- Accelerated: This means faster than normal treatment given over a short period of time, usually 3 times in one day over 12 consecutive days. The most frequently used accelerated treatment is: CHART (Continuous Hyperfractionated Accelerated RadioTherapy).
- SABR (Stereotactic Ablative Body Radiotherapy): Sometimes called SBRT (Stereotactic Body RadioTherapy), this is used to treat early-stage lung cancer when surgery isn’t an option due to a person’s health or in people who do not want surgery. SABR uses either many beams of radiation directed from different angles that meet at the tumour or the beam moves in an arc around the tumours. It is an effective way of giving highly accurate high dose radiotherapy with fewer treatments over a shorter period of time than standard radiotherapy.
Radiotherapy and chemotherapy
Radiotherapy can be given before chemotherapy, or at the same time as chemotherapy (concurrent chemoradiotherapy), or after completion of chemotherapy (sequential chemoradiotherapy). This is only used for limited small cell lung cancer or for localised or locally advanced non-small cell lung cancer.
If this applies to you, your doctor will discuss whether chemotherapy is appropriate for you and which type you will have. If given concurrently, chemotherapy is given the same day as radiotherapy. Before radiotherapy treatment, this can be given as a ‘Day Case’. Generally, people do not need to stay in hospital overnight.
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No, the treatment itself is totally painless, although you may find the treatment table hard and slightly uncomfortable.
Radiation used in medical treatment is given in controlled, carefully measured doses. The aim is to target all tissues that could possibly contain cancer cells while minimizing the dose to the normal tissue.
Radiotherapy does not make you radioactive. The radiation does not stay in your body after treatment, so you cannot do anyone else any harm. It is safe for you to still mix as you would normally with family and friends. There is no need to stay away from or not to touch others.
All forms of cancer treatment have side effects of one sort or another. Radiotherapy does have side effects. They vary from person to person, depending on the type of treatment you have and your general fitness.
Common short term side effects include:
- Skin reaction: Your skin in the treated area may become a little pink or red. It may also feel a little dry or itchy. You may bathe or shower during treatment, but do not have the water too hot. Use mild baby soap and try not to rub the treated area too hard. It’s best to pat the area dry with a soft towel. Avoid perfumed talcum powder or lotion.
- Problems with swallowing: This is caused by the swallowing tube (oesophagus) becoming irritated by the treatment. There are soothing liquid medicines that can be prescribed by your doctor. You may find cool/lukewarm drinks or ice-cream soothing. Eat soft or mushy food and avoid spicy or hot food, smoking and alcohol during treatment. The problem usually gets better within a week or two after radiotherapy has been completed.
- Hair loss: The areas of hair loss will only be from the areas of your body being treated such as your head. Speak to your doctor or nurse about whether you’re entitled to a free wig from the NHS if appropriate; although you may prefer to wear a scarf or hat. Most hair loss is temporary and will begin to grow again in two months after finishing treatment.
- Shortness of breath: Radiotherapy can make you feel more breathless because of inflammation in the lungs. Please let your radiographer or doctor know. You may be prescribed some medication for this.
- Tiredness: You may have been feeling fatigued for several weeks after treatment has ended. It is important to maintain a good sleeping routine and don’t feel that you must do everything that you do normally.
When my throat was sore after radiotherapy, I found creamy milkshakes the easiest to swallow.Zainab, living with lung cancer
Radiotherapy can also cause the following long-term side effects, including:
- Scarring of the lungs (fibrosis)
- Scarring of the oesophagus (swallowing tube)
- Spinal cord / heart damage
- Poor concentration and memory loss.
You will be given a contact phone number to phone if you experience difficulties with side effects. This number should be used at times when it may be diffi cult to contact your lung cancer nurse specialist or doctor, such as during the night or at the weekend.
You should try to maintain a healthy diet. You are more likely to get the energy you need if you eat little and often.
Focus on eating foods that will give you more energy (calories) and protein. Smaller meals can be less of a challenge, so try three smaller meals with extra snacks and nourishing drinks such as milkshakes or fruit smoothies in between to keep your weight stable.
Try to avoid things like alcohol, very hot drinks, rough foods such as crisps, crusty bread and strong spices if your throat has become irritated.
Try mashing foods, adding sauces/gravies, or mixing smoothies. If you experience a burning feeling in your throat and have difficulty swallowing, there is a medicine that can be prescribed to ease this discomfort.
The treatment can go on working for many weeks after the radiotherapy course has finished, so it is sometimes difficult to know straight away whether there has been a response.
Your doctor will use a combination of x-rays and scans to find out if there has been a reduction in the size of your tumour. Usually the doctors wait a few months before doing a scan to allow the treatment to work.
If there is evidence that your cancer is not responding to radiotherapy treatment, or if you are experiencing unmanageable side effects with it, your oncologist responsible for your care will have a very important meeting with you to discuss the benefits, risks and side effects of further treatment options.
You have the right to consider whether you wish to continue or have further radiotherapy treatment. This is a decision that you can make:
- Weighing up the benefits
- How treatment is affecting you, and
- The future risk of continuing or stopping.
Your clinical team will be able to offer advice, but will respect your right to choose. If you decide to stop radiotherapy your doctor will discuss any further treatment options; medicines or treatments to manage the symptoms of your cancer.