Radiotherapy

My doctor has told me that I need radiotherapy. What does this mean?

Radiotherapy is a general term for the treatment of cancer with x-rays. It works by killing cancer cells and is often used on its own to treat lung cancer. It may also be given as part of a combined treatment with surgery and/or chemotherapy. It is usually given from outside the chest (external radiotherapy) by directing x-rays at the area needing treatment. The machines that are most commonly used for this are called linear accelerators. However, radiotherapy can also be given by putting a small amount of radiation directly inside the lung (brachytherapy). Your cancer specialist (oncologist) will discuss with you the recommendations for radiotherapy.

The following information in this section is referring to external radiotherapy. Radiotherapy is only given in specialist cancer centres because the treatment is very specialised and expensive. This may involve long journeys to get to your nearest cancer centre, depending on where you live.

Why is radiotherapy used to treat lung cancer?

Radiotherapy has always been an effective treatment for lung cancer. It is the most common treatment used for non-small cell lung cancers, as in general they are slow growing tumours.

Small cell lung cancer can also be treated with radiotherapy and can also be given with chemotherapy or after completion of chemotherapy.

Radiotherapy can also be particularly helpful for treating lung cancer that has spread outside of the lungs to other parts of the body.

The list below describes the types of radiotherapy available and why they are prescribed:

Radical Radiotherapy

Why is it given?
To try and cure lung cancer, which is not suitable for surgery. The cancer must be small enough and in a suitable position so that the radiotherapy beam can totally surround it.

How is it Given?
Daily treatments, at a Cancer Centre. Usually given over a period of around four weeks.

Stereotactic Radiotherapy

This treatment is available only in specific Cancer Centres.
If someone is not fit enough for surgery then this treatment maybe considered. Solitary small lung tumours may be treated with stereotactic radiotherapy. Treatment is delivered to the tumour from many different points.The radiotherapy beam is targeted very accurately with this type of treatment and requires only a few hospital visits. Please click to see the Patient Information Leaflet

Continuous Hyperfractionated Accelerated Radiotherapy (CHART)

Why is it given?
A newer way of giving radical radiotherapy over a shorter period of time.

How is it given?
Three treatments a day, over 12 days, at a cancer centre.

Palliative Radiotherapy

Why is it given?
To shrink the tumour and help reduce symptoms such as cough, pain and breathlessness.

How is it given?
Usually daily treatments, for a short length of time. The amount needed varies from 1-15.

Stereotactic Radiosurgery (Gamma Knife - Brain)

In lung cancer, the disease can spread to the brain. If there is a solitary brain metastasis then this treatment may be possible. This is really another type of stereotactic radiotherapy. The main difference is that you have radiosurgery as a single dose of treatment. Sometimes this treatment is named after one of the machines used to give it – the gamma knife. But this is only one type of machine. You may have radiosurgery using the more common radiotherapy machine, the linear accelerator. The treatment is very high dose.

Specialists don't recommend this type of treatment for medium or large size tumours. It isn't possible to get the same dose of radiotherapy throughout the treatment area with a large tumour. If there are nerves running through the treatment area, they could receive too much radiation and get damaged. This could cause problems such as hearing loss, depending on what the affected nerve is for and where it was. Please click here to view a patient information leaflet.

For more information on Steroetactic Radiosurgery goto http://www.gammaknife.org.uk/

Prophylactic Cranial Irradiation (PCI)

Why is it given?
To reduce the chance of disease spreading to the brain after a complete or good response to chemotherapy

How is it given?
Daily treatments, usually from between 5 and 10 days.

Consolidation Radiotherapy

Why is it given?
To reduce the chance of cancer in the lung growing again after chemotherapy.

How is it given?
Daily treatments usually over around three weeks.

There are currently clinical trials underway to find out if chemotherapy and radiotherapy work better when given at the same time.

How will the doctors know how many treatments I need?

Your doctor will look at your test results, the type of tumour you have, where it is and whether it has spread. All this information will be carefully considered before the doctor decides how many treatments you need. This is called treatment planning and may involve:

• CT Planning Scan - this is a special type of scan. It helps your doctor to plan your radiotherapy treatment accurately.
• Simulator - the simulator is a special x-ray machine similar to the radiotherapy treatment machine and is used to plan the treatment to ensure that only the area that needs treatment will actually be treated.

Your treatment may be planned using either or both of these, and sometimes it may take several visits before your treatment is ready to start.

Is receiving radiotherapy treatment painful?

No, the treatment itself is totally painless, although you may find the treatment table hard and slightly uncomfortable.

How do the doctors know if the radiotherapy is working?

It is sometimes difficult to know immediately whether there has been a response, because the treatment itself can cause changes to the lungs. However, in time the response will become clearer, at which time repeat measurements from initial tests may help to establish if there is any change.

Should I change my diet during radiotherapy?

Try to maintain a healthy diet, but avoid very hot drinks, rough foods and strong spices, particularly if your gullet has become irritated. Try mashing foods or adding additional sauces/gravies - if swallowing is still difficult liquidise your food to remove any lumps. If you experience a burning feeling in your gullet, drinking alcohol, especially spirits, may make it worse. Cutting back will help if you feel you cannot cut it out completely.

Are there any side-effects of radiotherapy?

Yes, although they vary from person to person depending on the type of treatment you have and your general fitness. Some of the more common side-effects are shown in the following table.

“I was terrified when I first went for radiotherapy, but it wasn’t such an ordeal and it didn’t hurt at all.”

Possible Side Effects	Practical Advice
Some pain in the chest in the 24 hours after the first treatment.	This is usually mild and settles down fairly quickly. Use an “over-the-counter” painkiller and if this does not work speak to your GP or Lung Cancer Nurse Specialist.
Skin in the treated area becomes a little pink or red. It may also feel a little dry or itchy.	Use moisturising cream before, during and after treatment to the treatment area. You may bathe or shower during treatment, but do not have the water too hot. Use mild baby soap, but try not to rub the treated area particularly if it is red or itchy. It's best to pat the area dry with a soft towel. Avoid perfumed talcum powder or lotion.
Soreness when swallowing due to the gullet (oesophagus) becoming irritated by the treatment.	There are soothing liquid medicines which can be prescribed by your doctor. However, you may find cool/luke warm drinks or ice-cream soothing. Eat food that is soft or mushy, for example, porridge or soup. Occasionally, liquid morphine may be recommended.
Increase in your cough and sputum (spit).	Don’t worry, this is quite normal, but if you are having difficulties with it let your doctor know.
Tiredness following treatment.	This can last for a number of weeks after treatment has ended. Make sure that you take it easy and rest when you feel tired.
Scarring of the lung (fibrosis)	You might notice a slight increase in breathlessness. If this becomes a problem, see your hospital doctor or GP, as there are medicines and breathing exercises which can help.

 

How will I feel after treatment ends?

The effects of the treatment should wear off after several weeks - however tiredness can take a little longer. Your oncologist will arrange to see you a month or so after treatment is complete. It is important to assess how well your treatment is working and to ensure that you are not experiencing any other problems.

You can find more information at www.cancerbackup.org.uk/Cancertype/Lung/Treatment/Radiotherapy

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