Radiotherapy for lung cancer

What is radiotherapy?

Radiotherapy uses precise, carefully measured doses of high energy x-rays to treat cancer. Cancer cells are more sensitive to radiation than normal cells, so the aim of treatment is for the x-rays to either destroy the cancer cells or stop them from growing, whilst avoiding and protecting the normal cells as much as possible.

Radiation also damages normal cells in or around the area being treated which causes side effects, but these will usually recover and heal after treatment.

Why use radiotherapy to treat lung cancer?

Radiotherapy may be given to treat and attempt to cure lung cancer (radical radiotherapy) in cases where surgery is not felt to be the best treatment option. It is sometimes used following or alongside a course of chemotherapy treatment.

You will need to attend the radiotherapy department as an out-patient for a course of daily treatments (Monday to Friday) over a period of four to six and a half weeks.

Radiotherapy may also be used to relieve symptoms from lung cancer when the cancer has spread outside the lungs to other parts of the body (palliative radiotherapy). This would be a shorter course of treatment, with the aim of controlling symptoms and minimising side effects.

Your radiotherapy planning appointment

Prior to your radiotherapy treatment starting, you will need to attend the radiotherapy department for a CT planning scan. Depending on the area to be treated, it may be arranged for you to have a specially made mask to help keep your neck still during your treatment. This will be explained to you by the radiotherapy team if it is needed.

Some patients may be required to have abdominal compression as part of their treatment. This is used to reduce the amount your organs move during normal breathing. It is not painful and if suitable will need to be used every day when you have your treatment. It involves a piece of equipment that looks like a belt, being wrapped around your abdomen (stomach) before being inflated.

Part of your planning CT scan may involve us recording your breathing using a box placed on your chest at the same time as taking the scan. This allows us to build a moving picture of your chest to see how things move as you breathe so that we can take this into consideration when we plan your treatment.

Your radiotherapy treatment appointments

The actual radiotherapy treatment is like having an x-ray or scan. Each session takes approximately 15 minutes in total, most of which is spent ensuring you are in the correct position, although the actual delivery of the radiation lasts only a few minutes.

Short term side effects of radiotherapy treatment

Some side effects are short term, usually peaking about two to three weeks after you finish your treatment and then taking a further two to three weeks to improve. However, this will not be the case for all patients. Possible short term side effects from radiotherapy for lung cancer are:

Discolouration of skin

Your skin may become slightly discoloured in the treated area. We advise you not to soak in hot baths, to use a mild, non-perfumed soap and pat the area dry rather than rubbing. Do not use talcum powder or any lotions and creams other than those advised by us. Cream is available from the radiotherapy review specialist if you need it and wearing loose, natural fibre clothing also helps.

Tiredness

Radiotherapy may make you tired. Gentle exercise can help but save your energy for activities you enjoy doing.

Inflammation

Radiotherapy may cause inflammation of the lung causing a more frequent dry or wet cough. This should settle down when your treatment is over. You may also notice blood in your sputum (coughed up mucus), and breathlessness.

Breathlessness and a cough are also side effects you can experience after your treatment has finished. These should get better on their own within a few weeks, but you may require a short course of steroid tablets to manage this side effect.

Discomfort

You may develop discomfort in the area being treated. This is usually mild and can be relieved with painkillers.

Loss of body hair

You may notice that your body hair falls out in the treated area. This only happens in the area that has been treated and may grow back depending on the dose of radiotherapy.

You may experience some or all these side effects. Please always let the radiotherapy team know of anything worrying you, as we want to help you recover as soon as possible.

Long term side effects

Some side effects are long term. These usually occur around three months after finishing your course of treatment but can sometimes start much later.

Lung radiotherapy treatment will cause scarring of the lung tissue in the area where the cancer was treated. This scarring is permanent and could cause a small portion of the lung to collapse. The precise planning of your treatment minimises lung scarring. However, in some patients, this scarring could cause shortness of breath.

For tumours close to the ribs, there is a chance that the radiotherapy may weaken the ribs and cause pain or make it more likely that you break a rib rather than just bruise if you fall on this area of your body in the future.

For tumours close to the top of the lungs, there is a very small risk of the radiotherapy treatment damaging the nerves going to the arm. This could cause weakness or numbness in part of the arm. Great care is taken when planning your treatment to avoid or minimise the dose of radiation to these nerves.

Please let your doctor know if you experience any of these side effects as you may require additional tests and there may be treatments that can be offered to help.

After your treatment

You may be referred back to your surgeon, chemotherapy doctor or radiotherapy doctor for follow up care, depending on the treatment you have received.

Usually, you should expect an out-patient appointment to be arranged for four to six weeks after completing your treatment. This may sometimes be a telephone appointment. Out-patient appointments will then continue initially on a three to six monthly basis, or more frequently if required.