Radiotherapy for lung cancer

Radiotherapy uses high-energy x-rays to destroy cancer cells, while doing as little harm as possible to normal cells. It can be used in different situations, depending on the type and stage of lung cancer you have.

You will have a hospital appointment to plan your treatment. You will usually have a CT planning scan of the area to be treated. During the scan, you need to lie in the position that you will be in for your radiotherapy treatment.

You may need to have some small, permanent markings made on your skin. The marks are about the size of a pinpoint. They help the radiographer make sure you are in the correct position for each session of radiotherapy.

These marks will only be made with your permission. If you are worried about them, talk to your radiographer.

At the beginning of each session of radiotherapy, the radiographer positions you carefully on the couch and makes sure you are comfortable. Radiotherapy is not painful, but you have to lie still for a few minutes during the treatment. You are alone in the room during treatment. But you can talk to the radiographer, who is watching from the next room.

Radiotherapy for small cell lung cancer (SCLC) may be given:

• before or after chemotherapy, if the cancer is locally advanced (sequential chemoradiation )
• at the same time as chemotherapy, if the cancer is locally advanced (concurrent chemoradiotherapy)
• after chemotherapy, if the cancer has responded to treatment
• to control symptoms, if the cancer is more advanced or has spread to other parts of the body (palliative radiotherapy)
• to the head to stop any lung cancer cells that may have spread, forming a secondary cancer in the brain (prophylactic cranial radiotherapy).

CHART stands for continuous hyper-fractionated accelerated radiotherapy. You have radiotherapy 3 times a day including weekends, for 12 days. Each treatment must be at least 6 hours apart. You usually have to stay in the hospital or somewhere nearby during treatment.

Your doctor can tell you if CHART is suitable for you. It is not available at every hospital, so you may have to travel to have it.

If chemotherapy has been helpful, your cancer doctor may talk to you about having radiotherapy to the brain. This is called prophylactic cranial radiotherapy (PCR).

With SCLC, there is a risk that tiny numbers of cancer cells too small to see on a scan may have spread to the brain. Over time this could develop into a secondary cancer in the brain. PCR can reduce this risk and help people with SCLC to live longer. Your doctor and nurse will explain what is involved and what the side effects are before you decide.

You may get some side effects over the course of your treatment. Your doctor, nurse or radiographer will explain the side effects so you know what to expect. Tell them about any side effects you have. There are often things they can do to help. They will also give you advice on how you can manage side effects.

It can take 1 or 2 weeks after treatment before side effects start getting better. After this, most side effect usually slowly go away.

We have more information about the side effects of radiotherapy.

You may have:

• difficulty swallowing
• pain or discomfort when you swallow
• heartburn
• indigestion.

This is because radiotherapy can cause inflammation in the gullet (oesophagus).

Your doctor can prescribe medicines to help reduce the symptoms.

If you have difficulty eating, you can replace meals with nutritious, high-calorie drinks.

Tiredness can build up over your treatment. If you are having other treatments, you may feel more tired. Try to pace yourself and get plenty of rest.

Sometimes tiredness can continue for weeks or months after treatment finishes. If it does not get better, tell your doctor or nurse.

You may find your breathing gets worse during radiotherapy and for a few weeks or months after it finishes. This is because radiotherapy can cause inflammation in the area of the lung being treated. It may also give you a dry cough. Always tell your doctor or nurse if:

• you have these symptoms
• these symptoms get worse.

They may prescribe steroids to help improve your symptoms.

The skin in the treated area may get dry and irritated. The hospital staff will advise you on how to look after your skin. If it becomes sore, your doctor can prescribe cream to help.

This only happens in the treatment area. Men may lose hair on their chest, but it usually grows back. Occasionally hair loss is permanent.

We want everyone affected by cancer to feel our information is written for them.

We want our information to be as clear as possible. To do this, we try to:

• use plain English
• explain medical words
• use short sentences
• use illustrations to explain text
• structure the information clearly
• make sure important points are clear.

We use gender-inclusive language and talk to our readers as ‘you’ so that everyone feels included. Where clinically necessary we use the terms ‘men’ and ‘women’ or ‘male’ and ‘female’. For example, we do so when talking about parts of the body or mentioning statistics or research about who is affected.

You can read more about how we produce our information here.