Radiotherapy for lung cancer
What radiotherapy is
Radiotherapy uses high energy rays to kill cancer cells.
Cancer specialists use radiotherapy to treat all types of lung cancer.
For early stage lung cancer, the radiotherapy may aim to get rid of the cancer completely.
For non small cell lung cancer you may have radiotherapy on its own or with another treatment, such as chemotherapy or surgery. We have detailed information about radiotherapy for non small cell lung cancer (NSCLC).
For small cell lung cancer, radiotherapy is sometimes used with or after chemotherapy. Chemotherapy makes the tumour in the lung shrink. Giving radiotherapy as well improves the results. You may also have radiotherapy to your brain, which aims to kill off any cancer cells that may have spread to the brain. It is called prophylactic cranial irradiation (PCI). We have detailed information about radiotherapy for small cell lung cancer (SCLC).
For more advanced lung cancer the treatment aims to shrink the cancer and control it for some time to reduce symptoms such as coughing or breathlessness.
For non small cell lung cancer you may have radiotherapy on its own or with another treatment, such as chemotherapy or surgery. We have detailed information about radiotherapy for non small cell lung cancer (NSCLC).
For small cell lung cancer, radiotherapy is sometimes used with or after chemotherapy. Chemotherapy makes the tumour in the lung shrink. Giving radiotherapy as well improves the results. You may also have radiotherapy to your brain, which aims to kill off any cancer cells that may have spread to the brain. It is called prophylactic cranial irradiation (PCI). We have detailed information about radiotherapy for small cell lung cancer (SCLC).
For more advanced lung cancer the treatment aims to shrink the cancer and control it for some time to reduce symptoms such as coughing or breathlessness.
Your doctors will usually ask you to have breathing tests
before you have radiotherapy planning. You won't need to do this if your
treatment is to reduce symptoms though. The breathing tests measure how
much air you can breathe in and out. They may also test how much
exercise you can do before you get breathless. The tests don't hurt but
they can be a bit tiring.
Most radiotherapy for lung cancer is external treatment. The
radiation is aimed at your body from a machine and is similar to having
an X-ray. You have the treatment in the hospital radiotherapy
department. Your treatment plan will depend on what type and stage of
cancer you have.
If you are having radiotherapy to try to cure your lung cancer (radical radiotherapy) you may have between 20 to 36 treatments. You might have one treatment each day, from Monday to Friday, over 4 to 7 weeks. Or you might have 3 radiotherapy treatments each day for about 12 days, meaning you have treatment at the weekends too. This type of radiotherapy is known as CHART – continuous hyperfractionated accelerated radiotherapy. There is detailed information about CHART radiotherapy for lung cancer in this section.
If you are having radiotherapy to help control symptoms, you may have one treatment, two treatments about a week apart, or daily treatments for up to 3 weeks.
Having external radiotherapy does not make you radioactive. It is perfectly safe to be with other people, including children, throughout your treatment course.
If you are having radiotherapy to try to cure your lung cancer (radical radiotherapy) you may have between 20 to 36 treatments. You might have one treatment each day, from Monday to Friday, over 4 to 7 weeks. Or you might have 3 radiotherapy treatments each day for about 12 days, meaning you have treatment at the weekends too. This type of radiotherapy is known as CHART – continuous hyperfractionated accelerated radiotherapy. There is detailed information about CHART radiotherapy for lung cancer in this section.
If you are having radiotherapy to help control symptoms, you may have one treatment, two treatments about a week apart, or daily treatments for up to 3 weeks.
Having external radiotherapy does not make you radioactive. It is perfectly safe to be with other people, including children, throughout your treatment course.
Internal radiotherapy is also called brachytherapy or endobronchial therapy. You have the treatment during a bronchoscopy.
The radiation source is inside a narrow tube that the doctor puts
inside your airway for a few minutes. Doctors use this type of treatment
to shrink a tumour that is blocking or pressing on your airway and
making breathing difficult for you. There is more information about internal radiotherapy therapy in this section.
Radiotherapy treatment is carefully planned. Doctors use
X-rays and scans to plan the treatment, which is called virtual
simulation. They use these methods to work out exactly where to give the
treatment so that
The lungs are very sensitive to radiation, and so are other areas in the chest, such as your spinal cord. Because of this, doctors are very careful when they plan radiotherapy to the lungs. Occasionally you may need to have several planning sessions.
- It kills the most cancer cells
- It misses as much healthy lung tissue as possible
The lungs are very sensitive to radiation, and so are other areas in the chest, such as your spinal cord. Because of this, doctors are very careful when they plan radiotherapy to the lungs. Occasionally you may need to have several planning sessions.
External radiotherapy treatments only take a few minutes each
time. The radiographer will position you on the couch (usually lying
down) and make sure that you are comfortable. They may need to dim the
lights while they are setting up so they can see the laser guidance
beams. You won't have your treatment in the dark. Although you are left
alone while you have your treatment, the radiographers can hear and see
you.
Radiotherapy doesn't hurt. You won't be able to feel it, but you need to keep very still for a few minutes while you have the treatment. There may be special arm rests or cushions to help you to keep still. You may be asked to breathe in a certain way or hold your breath to reduce your chest movements during the treatment.
Internal radiotherapy treatments are given in different ways. For detailed information about internal radiotherapy look at the page about internal radiotherapy for lung cancer.
Radiotherapy doesn't hurt. You won't be able to feel it, but you need to keep very still for a few minutes while you have the treatment. There may be special arm rests or cushions to help you to keep still. You may be asked to breathe in a certain way or hold your breath to reduce your chest movements during the treatment.
Internal radiotherapy treatments are given in different ways. For detailed information about internal radiotherapy look at the page about internal radiotherapy for lung cancer.
- What radiotherapy involves
- How your radiotherapy treatment is planned
- Possible side effects
- Follow up
Our lung cancer reading list has information about books and leaflets about lung cancer treatments. If you want to find people to share experiences with online, you could use CancerChat, our online forum. Or you can go through My Wavelength. This is a free service that aims to put people with similar medical conditions in touch with each other.
Radical radiotherapy
Surgery is the most common treatment for stages 1, 2 and 3 non small cell lung cancer and is sometimes followed by chemotherapy.
But your doctor may suggest that you have radiotherapy instead of
surgery to try to get rid of the cancer cells. This is called radical
radiotherapy and your doctor may suggest it if one or more of the
following applies to you
- You can't have an operation due to a medical condition such as heart failure or chronic lung disease
- You have stage 3 cancer and the tumour is close to your heart
- The cancer is in an awkward place in the lung and surgery would be too difficult (an inoperable tumour)
There are two different ways of giving radical radiotherapy
treatment. One way means that you stay in hospital (or a patient hostel)
and have 3 treatments each day – 6 hours apart – for 3 weeks, including
weekends. This is called CHART (Continuous Hyperfractionated Accelerated Radio Therapy – CHART).
Another way gives 1 treatment each day, for between 4 to 7 weeks. You have this radiotherapy from Monday to Friday as an outpatient, so you may need to travel to the hospital each day or stay in a patient hostel. The dose of radiation with both ways of giving radiotherapy is about the same. Some research has shown that in some people CHART works better than having single daily radiotherapy treatments.
Government guidelines for lung cancer say that CHART should be offered to people needing radical radiotherapy who have
Another way gives 1 treatment each day, for between 4 to 7 weeks. You have this radiotherapy from Monday to Friday as an outpatient, so you may need to travel to the hospital each day or stay in a patient hostel. The dose of radiation with both ways of giving radiotherapy is about the same. Some research has shown that in some people CHART works better than having single daily radiotherapy treatments.
Government guidelines for lung cancer say that CHART should be offered to people needing radical radiotherapy who have
- Stage 1 or 2 NCSLC and can't have surgery
- Stage 3A or 3B NSCLC and are not fit enough to have chemoradiation
Doctors sometimes give chemotherapy along with radiotherapy.
Chemotherapy and radiotherapy together are called chemoradiation. Having
the treatments together increases the side effects and not everyone is
fit enough for this treatment. But if you have stage 2 or 3 non small
cell lung cancer and are well enough your doctor may suggest it to you.
Or you may have chemoradiation as part of a clinical trial.
You may have chemotherapy followed by radiotherapy for stage 3
lung cancers where the cancer has spread into lymph nodes on the
opposite side of the chest from the tumour.
Radiotherapy after surgery can slightly reduce the chance of
the cancer coming back in the lung for some people with early stage lung
cancer. This is called adjuvant radiotherapy. You usually only have
radiotherapy if the cancer has been completely removed with surgery. Or
if during surgery the surgeon finds cancer cells in the lymph nodes
close to the lung.
- 1 treatment only
- 2 treatments about a week apart
- A course of treatment over about 2 weeks
With a course of treatment over 2 weeks, the total dose of radiation is larger than with 1 or 2 treatments. But each individual dose of radiation is smaller because there are more treatments (about 10 instead of 1 or 2). Sometimes it is better to have treatment over 2 weeks if the doctor thinks a longer course may be helpful in your case.
A 2006 Cochrane review of clinical trials into radiotherapy for lung cancer symptoms showed that in most people shorter courses of 1 or 2 treatments are just as good at relieving symptoms such as coughing or chest pain as longer courses. Short courses also give fewer side effects.
For some fitter patients, a longer course of radiotherapy may give a slightly better chance of living for 1 or 2 years. But the longer course also gives more short term side effects, especially soreness on swallowing. You can read this review of radiotherapy for controlling symptoms of non small cell lung cancer in the Cochrane Library. It was written for researchers and specialists so is not in plain English.
Radiotherapy to the lung
Your doctor may suggest radiotherapy after or alongside chemotherapy for early stage small cell lung cancer
to help stop the cancer coming back in the lung. Radiotherapy after
chemotherapy is called adjuvant radiotherapy. Your doctor will be most
likely to suggest this treatment if your cancer has shrunk a lot or
disappeared after your chemotherapy.
Radiotherapy and chemotherapy given together are called chemoradiation.
Radiotherapy and chemotherapy treatment can get rid of small cell lung cancer completely for some people, so that there is no sign of your cancer on scans or when you are examined. This is called a complete response. But sometimes the cancer can come back after treatment, so you will have regular check ups.
You may have the radiotherapy treatment to the chest once a day over about 3 to 6 weeks. Or you may have it twice a day for 3 weeks.
Radiotherapy and chemotherapy given together are called chemoradiation.
Radiotherapy and chemotherapy treatment can get rid of small cell lung cancer completely for some people, so that there is no sign of your cancer on scans or when you are examined. This is called a complete response. But sometimes the cancer can come back after treatment, so you will have regular check ups.
You may have the radiotherapy treatment to the chest once a day over about 3 to 6 weeks. Or you may have it twice a day for 3 weeks.
Your doctor may suggest that you have radiotherapy to the head
because small cell lung cancer can spread to the brain. Giving
radiotherapy to the brain over 1 to 3 weeks makes it much less likely
that this will happen. The radiotherapy can also help some people to
live longer. This type of radiotherapy is called PCI or prophylactic
cranial radiotherapy.
Radiotherapy treatment to the brain can cause short term side effects that include tiredness, headaches and feeling or being sick for a few weeks. Your doctor can give medicines to reduce these effects. If you are very tired you may need to rest a lot and have help and support from your family or friends.
Radiotherapy treatment to the brain can cause short term side effects that include tiredness, headaches and feeling or being sick for a few weeks. Your doctor can give medicines to reduce these effects. If you are very tired you may need to rest a lot and have help and support from your family or friends.
You might also have radiotherapy to treat symptoms of lung cancer that has spread to the brain (brain secondaries). Brain secondaries are also called cerebral metastases. There is detailed information about controlling symptoms of lung cancer and treating secondary brain tumours in the section about treatment for advanced lung cancer.
About internal radiotherapy for lung cancer
Internal radiotherapy is also called brachytherapy or endobronchial therapy. The radiotherapy is given from inside
the lung airway. It is sometimes used when a tumour is blocking, or
partly blocking, your airway. If an airway is blocked this can make you
feel breathless and may cause a particular type of noisy breathing
called stridor.
Internal radiotherapy can shrink the blockage to help make your breathing easier and quieter. It can also help to control infections and bleeding caused by the tumour. You might have internal radiotherapy in combination with other treatments to relieve a blocked airway.
Radiotherapy given in this way can be repeated 2 or 3 times if necessary.
Internal radiotherapy can shrink the blockage to help make your breathing easier and quieter. It can also help to control infections and bleeding caused by the tumour. You might have internal radiotherapy in combination with other treatments to relieve a blocked airway.
Radiotherapy given in this way can be repeated 2 or 3 times if necessary.
You usually have a local anaesthetic
and a medicine to make you drowsy called a sedative. Your doctor then
puts a long, thin, flexible tube called a bronchoscope either down your
nose, or into your mouth and into your windpipe.
This can be a bit uncomfortable, but it doesn't last long. The doctor puts a thin tube called a catheter down the bronchoscope so it is close to the tumour. They then take the bronchoscope out and put a radioactive source down the catheter. The source is a radioactive metal and gives a dose of radiation to a small area around it. The doctor leaves it in place for a few minutes. The treatment does not hurt. The doctor then takes out the radioactive source and catheter. Once the radioactive source is out you are not radioactive so it is safe to be with other people.
This can be a bit uncomfortable, but it doesn't last long. The doctor puts a thin tube called a catheter down the bronchoscope so it is close to the tumour. They then take the bronchoscope out and put a radioactive source down the catheter. The source is a radioactive metal and gives a dose of radiation to a small area around it. The doctor leaves it in place for a few minutes. The treatment does not hurt. The doctor then takes out the radioactive source and catheter. Once the radioactive source is out you are not radioactive so it is safe to be with other people.
Side effects of lung cancer radiotherapy
The side effects will depend on the type of radiotherapy you
have. A few weeks of treatment will usually give more side effects than
treatment given in one or two doses. The side effects of radiotherapy
for lung cancer usually come on slowly and last for a few weeks after
your treatment has ended. Once the treatment is over, the side effects
will gradually get better. A small number of people have long term side effects, which develop up to 2 years after treatment has finished.
Some side effects of radiotherapy are caused by its effect on normal tissue in your body. These may include
Try to rest as much as you can. If you feel that you want to have a lie down, then you probably need to do just that.
It may be uncomfortable to drink very hot, or very cold, drinks. Let hot drinks cool a little before you drink them and don't keep cold drinks in the fridge. Very rarely, doctors may give extra fluids by a drip if you aren't able to drink enough.
If you have difficulty swallowing you may find that having a soft diet is easier until your treatment is over. Foods such as soups and stews are easier to swallow than more solid foods such as grilled meats. Radiotherapy departments often have diet sheets to help advise you. We have information about soft diet, which you may find useful.
Your doctor may be able to give you medicines such as anaesthetic mouthwashes and antacids to help reduce the soreness. If you have severe pain when you swallow, you may need to take strong painkillers. The soreness will get better by itself, but this often takes a couple of weeks after the treatment has finished.
Sometimes hair loss is permanent after radiotherapy. It depends on the dose of radiotherapy you have. If you are worried about this, ask your doctor or nurse about how likely hair loss is in your case.
If you don't feel like eating, try drinking high calorie drinks. You can get a prescription for these from your doctor. Or you can buy them at the chemist.
The most common skin reaction is like a mild sunburn, with redness and irritation. Having radiotherapy with, or soon after, chemotherapy may make the skin reaction worse. To help stop your skin getting sore you need to wash the treatment area with plain water only. Don't use perfumed soap or washing products unless you have discussed this with your cancer specialist, radiotherapy nurse, or radiographer.
If your skin is getting sore, tell your radiographers so they can keep an eye on it. People have different reactions to radiotherapy. Your radiographers can take steps to reduce your soreness and discomfort if they know there is a problem.
- Tiredness and feeling run down
- A sore throat and trouble swallowing
- Cough
- Hair loss
- Chest pain
- A temperature and shivering
- Feeling sick
- Sore skin in the treatment area
Tiredness and feeling run down
You are more likely to feel tired if you have treatment over a few weeks. You may find that you become more and more tired as your treatment goes on. This is normal with radiotherapy. It may be partly due to travelling back and forth to the hospital. And it may partly be an effect of the treatment itself. The tiredness may last for a few weeks after the end of treatment.Try to rest as much as you can. If you feel that you want to have a lie down, then you probably need to do just that.
A sore throat and trouble swallowing
Your throat may become sore about 2 to 3 weeks into your treatment, perhaps sooner if you are having chemotherapy and radiotherapy together. This soreness can start quite suddenly, which can be a bit alarming. Do tell your doctor or radiographers if you are having problems swallowing so they can advise you on ways to reduce this.It may be uncomfortable to drink very hot, or very cold, drinks. Let hot drinks cool a little before you drink them and don't keep cold drinks in the fridge. Very rarely, doctors may give extra fluids by a drip if you aren't able to drink enough.
If you have difficulty swallowing you may find that having a soft diet is easier until your treatment is over. Foods such as soups and stews are easier to swallow than more solid foods such as grilled meats. Radiotherapy departments often have diet sheets to help advise you. We have information about soft diet, which you may find useful.
Your doctor may be able to give you medicines such as anaesthetic mouthwashes and antacids to help reduce the soreness. If you have severe pain when you swallow, you may need to take strong painkillers. The soreness will get better by itself, but this often takes a couple of weeks after the treatment has finished.
Cough
It is quite common to develop a cough during or after radiotherapy for lung cancer. You may have a sticky cough – with mucus to bring up. Or you may have a dry, tickly cough. You can ask your doctor or nurse for cough medicine, but this may not help much. The cough should go away when the treatment is over. You need to tell your doctor if you have a cough or if you cough up coloured sputum, particularly if you feel feverish or unwell. The cough might be due to an infection, rather than the treatment, and you could need antibiotics.Hair loss
You will only get hair loss in the area being treated. So you may lose hair on your chest. Or if you are having radiotherapy to the brain you may lose some hair on your head. The hair usually grows back within a few months, but it can be patchy.Sometimes hair loss is permanent after radiotherapy. It depends on the dose of radiotherapy you have. If you are worried about this, ask your doctor or nurse about how likely hair loss is in your case.
Chest pain
Chest pain can happen when you are having radiotherapy to the chest in one or two doses. It usually occurs within 24 hours of having the treatment. It is nothing to worry about and goes away by itself. But it is important to let your doctor or nurse know in case the pain is caused by something else. They can prescribe painkillers for you.Temperature and shivering
You may have a raised temperature and feel shivery if you have treatment in one or two doses. You can ask your doctor if it is all right to take a couple of paracetamol if this happens. It should pass quite quickly. Paracetamol will usually stop the shivering and bring down your temperature. Let your doctor or nurse know if you have these symptoms because they can sometimes be due to a chest infection. If you have a chest infection, you may need antibiotics to clear it up.Feeling sick
You may feel sick while you are having radiotherapy for lung cancer, but is unusual. It depends on which part of the lung is being treated. If you feel sick let your doctor, nurse or radiographer know. You can have anti sickness drugs to control it.If you don't feel like eating, try drinking high calorie drinks. You can get a prescription for these from your doctor. Or you can buy them at the chemist.
Sore skin in the treatment area
Radiotherapy can make the skin sore in the area being treated. It might happen if you are having radiotherapy for a pancoast tumour, but for other types of lung cancer it is rare.The most common skin reaction is like a mild sunburn, with redness and irritation. Having radiotherapy with, or soon after, chemotherapy may make the skin reaction worse. To help stop your skin getting sore you need to wash the treatment area with plain water only. Don't use perfumed soap or washing products unless you have discussed this with your cancer specialist, radiotherapy nurse, or radiographer.
If your skin is getting sore, tell your radiographers so they can keep an eye on it. People have different reactions to radiotherapy. Your radiographers can take steps to reduce your soreness and discomfort if they know there is a problem.
Unfortunately, doctors can't tell beforehand who is going to get long term side effects and who isn't. People vary quite widely in their reactions to radiotherapy and a few people seem to be more than usually sensitive. It is important to remember that treating your cancer is the priority. But your radiotherapy specialist team will do all they can to try to make sure long term side effects don't happen. And they will discuss any possible side effects with you before you agree to have the treatment.
Long term side effects happen because radiotherapy can make fibrous tissue develop. This is called fibrosis. Fibrous tissue is less stretchy than normal tissues. You may have breathlessness, narrowing of your food pipe (oesophagus), or effects on the heart and spinal cord.
No comments:
Post a Comment