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 therapy may be used as part of the main treatment instead.

• If you recently had surgery for NSCLC, radiation might be given to help kill any remaining cancer cells. You may also get chemotherapy in addition to radiation therapy. This is called adjuvant therapy.

• If you are getting ready to have surgery for NSCLC, you may get radiation therapy along with chemotherapy before surgery. This is called neoadjuvant therapy. The goal is to shrink the tumor so it is easier to take out with surgery.

• If you have complications from NSCLC that has spread to other parts of the body, radiation may help ease these. Symptoms include bone pain or nervous system problems. Radiation used in this way is called palliative therapy because it can help you feel better but won’t cure your cancer.

For small cell lung cancer (SCLC)

• If you have limited stage SCLC, radiation therapy is usually 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 complications from NSCLC that has spread to other parts of the body, radiation may help ease these. Symptoms include bone pain or nervous system problems. Radiation used in this way is called palliative therapy because it can help you feel better but won’t cure your 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 an X-ray beam. This is called external radiation. Less often, a radiation source is put into the body and into or right next to the tumor in the lung. 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 need the therapy. If you need radiation combined with chemotherapy, you will also see a doctor called a medical oncologist.

External radiation therapy

You can usually get external radiation therapy as an outpatient in a hospital or a clinic. For tumors in the lungs, you usually 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 tumors in the lungs for some very early stage cancers. Because high doses of radiation are used, this type of radiation can be given in just one or a few 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 will 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 your 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. 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. These help doctors know exactly where your tumor is to better aim the radiation. Also at this session, you may have body molds made. The molds help keep you from moving during the treatment.

On the days you get radiation

On the days you get radiation treatment, you will lie on a table while the machine is placed over you. You may have to wear a hospital gown. The experience is much like getting an X-ray, but it takes about 15 to 30 minutes to complete. You should plan on being there for about an hour.

At the start of the treatment session, a radiation therapist may place blocks or special shields. 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 radiation is being given. During the session, you will be able to talk to the therapist over an intercom. You can’t feel radiation, so the process will be painless. Also, you will not be radioactive afterward.

Internal radiation therapy (brachytherapy)

This is used less often for lung cancer. For this treatment, small radioactive pellets are put into or near the tumor. One way to put the pellets into your lung is through your windpipe using a bronchoscope. You may need to stay in the hospital while the pellets are inside you. You may have nausea as a side effect.

What to expect after radiation therapy

Because radiation affects normal cells as well as cancer cells, you may have some side effects from this treatment. Some people have few or no side effects. If you do have them, your doctor may change the dose of your radiation or how often you get treatments. Or the doctor may stop treatment until the side effects are cleared up. Be sure to tell your doctor about the side effects you have. Here’s a list of effects that people with lung cancer may have after radiation:

• Fatigue

• Skin changes and hair loss in the area being treated

• Loss of appetite

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

• Coughing

• Shortness of breath

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

Most of these side effects will go away or get better within a few weeks after your treatment ends. Ask your doctor when you should call about the side effects.

You may feel better during your radiation treatments if you make an extra effort to get plenty of rest and eat healthy meals that are easy to swallow. It is important to try and maintain your weight during treatments for lung cancer.