Radiotherapy

Radiotherapy is a type of lung cancer treatment which uses high energy X-rays (radiation) to destroy cancer cells while avoiding normal cells. 

Radiation is given in small individual doses (fractions) aimed precisely at the tumour over a specified period ranging from a few days to as much as six and half weeks (up to 33 treatments).

In this section, we’ll explain:

• Radiotherapy and small cell lung cancer
• Radiotherapy and non-small cell lung cancer
• Receiving radiotherapy
• Potential side effects and how to manage them
• What happens after radiotherapy finishes.

Radiotherapy and small cell lung cancer

People with small cell lung cancer may be offered radiotherapy. This will depend on the stage of the cancer.

Limited stage small cell lung cancer means the cancer is contained within the lung and/or chest. Limited stage disease can be treated with radiotherapy to reduce the risk of cancer returning.

Radiotherapy can be given after chemotherapy or at the same time as chemotherapy. 

If it is given at the same time, the radiotherapy part of this treatment is usually started with second round of chemotherapy. If your cancer is larger, your radiotherapy might start with a later cycle of chemotherapy, or after your course of chemotherapy has finished. 

Extensive stage small cell lung cancer means the cancer is much larger or has spread more widely. 

Extensive-stage small cell lung cancer is not suitable for radical radiotherapy. However, palliative radiotherapy may be used to treat small cell lung tumours. Radiotherapy may also be used to treat small cell lung cancer that has responded to chemotherapy.

Radiotherapy and non-small cell lung cancer

Radiotherapy is one of the main treatments for non-small cell lung cancer. It may be given: 

• to try to cure lung cancer if it cannot be treated with surgery. This is called radical radiotherapy.
• after surgery to reduce the risk of the lung cancer coming back. This is called adjuvant radiotherapy.
• with chemotherapy to treat and manage the lung cancer. This is called combination therapy.
• before surgery and in combination with chemotherapy to reduce the risk of the lung cancer coming back. This is called multimodality therapy.
• to control symptoms if the lung cancer has spread to other parts of the body, such as the brain or bones. This is called palliative radiotherapy.

Receiving radiotherapy

Before you begin actual radiotherapy treatment, you will be asked to come as an out-patient for a planning session. During this session, you will have a CT scan.

After the scan, radiographers will need to put up to four tiny dots on your skin using a felt-tip pen. At the end of the session, you will be asked for permission to make these marks permanent by tattooing very small dots. These tattoo dots ensure that you are in exactly the same position to receive the radiotherapy. 

How soon radiotherapy treatment starts after planning appointments varies. Some palliative or urgent treatments may start within a few days. Others, including more complex treatments, may start after a week or two.

Radiotherapy sessions typically last for around 10 to 20 minutes, though they may be longer depending on the treatment you are receiving, such as for SABR.

When you receive your treatment, you will lie in the same position as you were in for your planning session. Try to lie still and relax. 

Often before starting the actual treatment a scan is taken using the treatment machine. This scan is a cone beam CT and is used to check the position of the area being treated before the machine is turned on.

You will see the machine rotating around you and hear a buzzing noise. The cone beam CT scans then take a few minutes to analyse and it may be necessary to adjust the position of the treatment couch. At this point, you may feel the couch being moved a little. 

The linear accelerator will then be turned on to give the radiation treatment. It will be delivered either from a number of different directions or as it rotates around you. The machine will make a noise as it moves around you, and bleeps will be heard when radiation is being delivered. 

You will not feel anything during the treatment.

When the treatment session is over, you will be free to leave the hospital.

Side effects of radiotherapy

Like all cancer treatment, radiotherapy does have side effects. Side effects may develop during treatment, but both the timing and how they appear vary from person to person. Some side effects can begin during your treatment and may continue for a short time after your treatment has finished, others can appear later and can be permanent

Short-term side effects of radiotherapy include:

Tiredness

You may have been feeling fatigued for several weeks after treatment has ended. Maintain a good sleeping routine and don’t feel that you must do everything that you do normally. Listen to what your body is telling you, and if you feel tired then rest. Ask your family and friends for help. 

For people in good general health, it may be beneficial to do some gentle exercises at a level you find comfortable – even just walking to the shops.

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. It usually gets better within a week or two after radiotherapy has been completed.

Soothing liquid medicines can be prescribed. You may find cool/ lukewarm drinks or ice-cream soothing. 

Eat soft or mushy food, for example, porridge or soup. It’s best to avoid spicy or hot food, smoking and alcohol during treatment. 

Shortness of breath

Radiotherapy can make you feel more breathless because of inflammation in the lungs. It is important to let your radiographer or doctor know if you feel breathless. You may be prescribed some medication for this.

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.

Long-term side effects of radiotherapy include:

Scarring of the lungs

This might lead to your lung not working quite as well as it did before. You might notice a slight increase in breathlessness. If this becomes a problem, see your hospital doctor or GP, as there are medicines and breathing exercises which can help but the breathing deterioration can be permanent.

Oesophagus scarring

In very rare circumstances, this makes it difficult to swallow solid food. Occasionally, a procedure is required to dilate or stretch the oesophagus.

Spinal cord/ heart damage

As the treatment is often close to the spinal cord and heart there is a very rare chance they may be damaged. Your doctor will explain if you are potentially at risk of damage.

Chest pain

This may be a long-term side effect particularly if you have had SABR rather than conventional radiotherapy. This pain may be associated with a rib fracture due to its weakening following treatment.

Poor concentration and memory loss

People are often concerned that radiotherapy to the brain will affect their memory and overall cognitive function. If you are worried about how you are feeling after treatment, speak to your cancer doctor or lung cancer nurse.

What happens after radiotherapy finishes

Your oncologist or referring chest doctor will arrange an appointment a few weeks after your treatment has finished. This may be at the hospital or over the telephone and may be with your lung cancer nurse specialist rather than your doctor. 

You will then begin to have appointments at regular intervals to assess how well your treatment is working and to ensure that you are not experiencing any other problems. 

If you have had radical (curative) radiotherapy, you will normally have a scan between three and six months after treatment finishes. When you have had the scan, you will then have an appointment with your oncologist to discuss the results.