Lung Cancer: Radiation Therapy
What is radiation therapy?
Radiation therapy uses high-energy radiation from X-rays or particles to kill cancer cells.
When might radiation therapy be used?
There are several cases in which your healthcare provider may recommend radiation therapy:
For non-small cell lung cancer (NSCLC)
If you have NSCLC and can’t have surgery, radiation may be used as part of the main treatment. In this case, it's often given along with chemotherapy.
After surgery, radiation might be given to help kill any remaining NSCLC cells. You may also get chemotherapy with the radiation therapy.
If you're going to have surgery for NSCLC, you may get radiation therapy, often along with chemotherapy, before surgery. The goal is to shrink the tumor so it's easier to remove.
Radiation can be used to treat a single area of cancer spread, such as a tumor in your brain or in an adrenal gland.
If you have problems caused by NSCLC that has spread to other parts of your body, radiation may help ease these. For instance, radiation can help ease bone pain, trouble swallowing, or nervous system problems. Radiation used in this way is called palliative therapy. It can help you feel better but won’t cure the cancer.
For small cell lung cancer (SCLC)
If you have limited stage SCLC, radiation therapy is often used along with chemotherapy as the main treatment.
If you have extensive stage SCLC that responds well to chemotherapy, you may get radiation therapy to the chest. This will help keep the cancer under control for as long as possible.
You may get radiation therapy to your head to help keep the cancer from spreading to your brain. This is called prophylactic cranial irradiation. This is more often used for limited stage SCLC. But it can also be used for extensive stage SCLC.
If you have problems, such as cough, trouble swallowing, or shortness of breath, caused by SCLC that has spread to other parts of your body, radiation may help ease these. Radiation used in this way is called palliative therapy. It can help you feel better but won’t cure the cancer.
To plan your entire treatment strategy, you will meet with a team of cancer specialists. This might include a surgeon, radiation oncologist, and medical oncologist.
What happens during radiation therapy?
For lung cancer, the most common way to get radiation is from a machine that sends out a beam of radiation. This is called external radiation. Less often, a radiation source is put into the body and into or right next to the tumor. This is known as internal radiation or brachytherapy.
A doctor who specializes in cancer and radiation is called a radiation oncologist. This doctor works with you to decide how the radiation will be given, the dose of radiation, and how long you'll need treatment. If you need radiation combined with chemotherapy, you'll also see a doctor called a medical oncologist.
External radiation therapy
You can often get external radiation therapy as an outpatient in a hospital or a clinic. This means you will go home the same day. For tumors in the lungs, you often get treatments 5 days a week. You will do this for several weeks, depending on the reason it's being given.
Stereotactic radiation therapy is a type of external radiation that uses high doses of radiation aimed at a tumor from many different angles. This type of radiation is used most often when lung cancer has spread to the brain. It may also be used to aim radiation at small tumors in the lungs when surgery isn't done. High doses of radiation are used. So this type of radiation can be given in just 1 to 5 treatments.
Getting ready for external radiation
Before your first radiation treatment, you will have a session to find out exactly where on your body the radiation beam needs to be aimed. The process is called simulation. This session may take up to 2 hours. During this session, you'll lie still on a table while a radiation therapist uses a machine to mark your treatment field. The field is the exact place on your body where the radiation will be aimed. Sometimes it’s called the treatment port. You may have more than one treatment field if you have cancer in more than one place.
The therapist may mark your skin with tiny dots of semi-permanent ink or tiny tattooed dots. The marks help make sure the radiation is aimed at the exact same place each time. You may have imaging tests such as CT scans done during simulation. These help doctors know exactly where the tumor is to better aim the radiation. Also at this session, you may have body molds made. The molds hold you in the exact same position and help keep you from moving during treatment.
On the days you get radiation
On the days you get radiation treatment, you'll lie on a table while the machine moves over and around you. You may have to wear a hospital gown. The treatment is a lot like getting an X-ray, but it takes longer. You should plan on being there for about an hour.
To start treatment, a radiation therapist helps you get in the right position. He or she may also place blocks or special shields over you. These protect parts of your body that don’t need to be exposed to radiation. The therapist then lines up the machine so that radiation is aimed at the spot that was marked during the simulation. When you are ready, the therapist leaves the room and turns the machine on. You may hear whirring or clicking noises while the machine moves and radiation is being given. The machine will not touch you. During treatment, you'll be able to talk to and hear the therapist over an intercom. You can’t feel radiation, so the process will be painless. Also, you won't be radioactive afterward.
Internal radiation therapy (brachytherapy)
This may be used for NSCLC cancer that's blocking your airways and causing breathing problems. For this treatment, small radioactive pellets are put into or near the tumor. One way to put the pellets in is through your windpipe (trachea). This is done using a long, thin, lighted tube called a bronchoscope. It's put in through your mouth. A camera on the end allows the doctor to see the tumor and put the pellets in the right place. The radioactive pellets can also be put in during surgery.
What to expect after radiation therapy
Radiation affects normal cells as well as cancer cells. So you may have side effects from this treatment. Some people have few or no side effects. If you do have them, your doctor may change your radiation dose or how often you get treatments. Sometimes treatment is stopped until the side effects are cleared up. Tell your treatment team about any side effects you have. Here’s a list of some of the more common side effects that people with lung cancer may have with radiation:
Extreme tiredness (fatigue)
Skin changes and hair loss in the area that's treated
Nausea and vomiting
Sore throat and trouble swallowing. This might make it hard to eat.
Shortness of breath
Problems with thinking or memory (with radiation therapy to the head)
You may feel better during your radiation treatments if you make an extra effort to get plenty of rest. And also eat healthy meals that are easy to swallow. Talk with your treatment team about what you can do to try to maintain your weight during treatment.
Most side effects go away or get better within a few weeks after treatment ends. But it's important to treat side effects right away, before they get worse. Tell your provider about any changes you notice. Know what signs to look for and when to call them. Make sure you know what number to call with questions. Is there a different number for evenings and weekends?
It may be helpful to keep a diary of your side effects. A written list will make it easier to remember your questions when you go to appointments. It will also make it easier for you to work with your healthcare team to make a plan to manage side effects.