Lung Cancer: Radiation Therapy

What is radiation therapy?

Radiation therapy uses beams of energy from strong X-rays or particles to kill cancer cells.

When might radiation therapy be used?

There are many ways radiation therapy can be used to treat lung cancer:

For nonsmall cell lung cancer (NSCLC)

• Radiation may be used as part of the main treatment if the tumor can't be removed with surgery. This may be because the tumor is very big or in a place that makes it hard to get out. Or maybe you don't want surgery or are not well enough to have it. In this case, radiation is often given along with chemotherapy. This is called chemoradiation. Or if the cancer is very early stage, the radiation could be given on its own.

• After surgery, radiation (maybe with chemo) might be given to help kill any remaining NSCLC cells.

• If you're going to have surgery for NSCLC, you may get radiation therapy (often along with chemo) 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 (metastasis), like a tumor in the 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 it won’t cure the cancer.

For small cell lung cancer (SCLC)

• If you have limited stage SCLC, the cancer is in one lung and in one area. Radiation therapy is often used along with chemotherapy as the main treatment. This is called chemoradiation.

• Radiation may be given after chemo for people with extensive stage SCLC if they responded well to the chemotherapy, or if they have limited stage SCLC and can't tolerate chemoradiation. This could 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. It's most often used for limited stage SCLC. But it can also be used for extensive stage SCLC.

• If you have problems caused by SCLC that has spread to other parts of your body, radiation may help ease them. For instance, it can help with cough, trouble swallowing, pain, or shortness of breath. Radiation used in this way is called palliative therapy. It can help you feel better, but it won’t cure the cancer.

You will meet with a team of cancer specialists to make a radiation therapy treatment plan. The team might include a surgeon, radiation oncologist, and medical oncologist.

What happens during radiation therapy?

The most common way to get radiation for lung cancer is from a machine that sends out a beam of radiation. This is called external beam radiation therapy. In rare cases, a radiation source is put right into or next to the tumor. This is known as internal radiation or brachytherapy. 

A healthcare provider who specializes in cancer and radiation is called a radiation oncologist. This provider 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 along with chemotherapy, you'll also see a healthcare provider called a medical oncologist.

External beam radiation therapy

You get external beam radiation therapy as an outpatient in a hospital or a clinic. This means you go home the same day. For lung tumors, treatment is done 5 days a week. It's usually done for 3 to 7 weeks, depending on the type of radiation used and 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'll have a session to find out exactly where on your body the radiation beam needs to be aimed. The process is called simulation. It 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 semipermanent ink or tiny tattooed dots. The marks help make sure the radiation is aimed at the exact same place each time. Imaging tests, such as CT scans, might be done during simulation. These help healthcare providers know exactly where the tumor is to better aim the radiation. Body molds might also be made. These hold you in the exact same position each time and help keep you from moving during treatment. Tumors in the lung may move during treatment because of your normal breathing, so several scans may be done during simulation. In this way, the tumor's location throughout the entire breathing cycle can be captured. The tumor is always being targeted when you finally begin radiation.

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. Each 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. Blocks or special shields may be put over you. Or the head of the machine may have these blocks built into it. These help 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 spots that were made during the simulation.

When you're ready, the therapist leaves the room and turns the machine on. You may hear whirring or clicking noises while the machine moves and the radiation is 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, and it doesn't hurt. Also, you won't be radioactive afterward.

Internal radiation therapy (brachytherapy)

This type of radiation 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(s) in your airways. 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 healthcare provider to see the tumor and put the pellets in the right place. The radioactive pellets can also be put in during surgery. They're taken out after a short time.

What to expect after radiation therapy

Radiation affects normal cells as well as cancer cells. So you may have side effects from this treatment. Ask your healthcare provider what short- and long-term effects you can expect. When chemo is given along with radiation, side effects tend to be worse.

If you have side effects, your healthcare provider may change your radiation dose or how often you get treatments. Sometimes treatment is stopped until side effects get better if the side effects are bad. Tell your treatment team about any side effects you have. Many can be treated, and some can even be prevented.

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 treatment field. The skin may get red, blister, and peel.

• No appetite

• Nausea and vomiting

• Sore throat and trouble swallowing. This might make it hard to eat.

• Coughing

• Shortness of breath

• Problems with thinking or memory (with radiation therapy to the head) 

Try to get plenty of rest during treatment. 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 over time after treatment ends. But it's important to treat side effects right away, so they don't 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 or problems. 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.