Radiation for Lung Cancer

Radiation treatment is a medical procedure for killing or disabling cancer cells in the lungs by using high-energy X-ray or particle beams. One of two methods delivers the radiation: a machine outside the body that directs a beam to the target area, or by small pellets or seeds with radioisotopes that are placed inside the body. Because radiation can damage healthy cells in addition to killing cancerous ones, precautions are taken to focus the radioactive effects on the cancer.

 In treating lung cancer, radiation therapy has two major functions. As a curative procedure, radiation eliminates disease from the body. As a palliative procedure, radiation relieves symptoms and controls pain, without providing a final cure. It can be used as a standalone therapy or in combination with surgery and/or chemical treatments. Radiation is especially effective for persons with an early-stage lung cancer that may be too weak to withstand surgery.

Radiation can play a critical role in the battle with lung cancer.

What Types of Radiation Treatment for Lung Cancer Are There?

There are two primary forms of radiation treatment for lung cancer: external beam radiation therapy, or EBRT, and brachytherapy or internal radiation therapy. There are variations on these technologies described below:

External Beam Radiation Therapy (EBRT)

• Three-dimensional Conformal Radiation Therapy (3D-CRT): With 3D-conformal radiotherapy, the external beam is precisely targeted by special machinery to irradiate only the tissue associated with the cancer (called the tumor bed). The patient is treated as many as five times a week for up to seven weeks. The treatment itself is painless, and lasts only a few minutes at a time.
• Intensity-modulated Radiation Therapy (IMRT): IMRT combines 3D targeting technology with an ability to control the intensity or dosage strength of the radiation beams. This creates an additional safeguard for protecting healthy cells from misdirected radiation. An IMRT-variant called volumetric modulated arc therapy (VMAT) is also used. It delivers a similar radiation dosage in shorter periods of time. 
• Stereotactic body radiation therapy (SBRT): This is an accelerated form of radiotherapy, where large doses are delivered in a relatively compact timeframe – typically one to five sessions. This method is showing promise in treating lung cancer with fewer complications. SBRT is also referred to as stereotactic ablative radiotherapy (SABR).
• Stereotactic Radio Surgery (SRS): A single large dose of radiation is delivered to the patient on a standalone basis or in conjunction with lung surgery.

All four of these techniques are used with non-small cell lung cancers. Small cell lung cancer is typically treated with 3D-CRT or IMRT.

Brachytherapy

With internal radiation therapy, the medical team inserts a catheter inside the lung at the tumor’s location. Radioactive pellets are placed inside the catheter for short periods of time, irradiating the surrounding tissues to kill nearby cancerous cells. Sometimes tiny pellets, called seeds, are left permanently inside the tumor. Brachytherapy is often used to shrink tumors before surgery or to reduce cancer-related symptoms and discomfort.

Internal radiation treatments are typically limited to cases involving non-small cell lung cancers.

When Is Radiation Therapy Used in Lung Cancer Treatment?

Radiation therapy is used to treat lung cancer in the following circumstances. If you’re suffering from the non-small cell variant, radiation is used:

• As a primary treatment, if the tumor is too large or too close to the center of the chest, or if the patient isn’t strong enough for surgery. 
• Before surgery to shrink tumors. 
• After surgery to kill cancer cells that tumor removal might have missed. 
• To attack tumors that have spread from the lungs to the brain or adrenal gland. 
• As a palliative, to relieve cancer-related symptoms and pain.

For persons with small cell lung cancer, radiation is used:

• As a primary treatment, when combined with chemotherapy (called chemoradiation).
• As a standalone treatment in advanced cases of the disease, or for patients who are unable to tolerate chemoradiation. 
• To attack tumors that have spread from the lungs to the brain.
• As a palliative, to relieve cancer-related symptoms and pain.

How Do I Prepare for Lung Cancer Radiation Therapy?

Radiation treatment requires preparation on the part of you and your medical team. That’s because radiation dosages must be precisely targeted to maximize their curative effect while minimizing damage to surrounding tissues. This is particularly critical with external-beam radiation. Planning may involve:

• Radiation simulation: During a simulation procedure, your physician will mark your body to improve positioning for the radiation session. If you’re undergoing brachytherapy, your medical team may also insert marker pellets in the tumor bed to guide introduction of the radioactive isotopes. 
• Planning scans: Your physician will take CT scans of your lung and chest cavity.

This preparatory work enables your physician to select the type and dosage of radiation best suited to treating your cancer.

What Are the Side Effects of Radiation Therapy for Lung Cancer?

Radiotherapy for lung cancer has a number of possible side effects:

• Nausea and vomiting
• Weakness and fatigue
• Blistering and peeling skin
• Hair loss
• Appetite reduction and weight loss
• Coughing, shortness of breath, and temporary lung damage
• Sore throat, swallowing difficulty, and short-term esophageal damage

What Happens After I Complete Radiation Therapy for Lung Cancer?

You’ll see your physician regularly after completing radiation therapy for lung cancer. He or she will evaluate the effectiveness of your treatment. This process will continue indefinitely. If the treatment is unsuccessful or your cancer returns, your physician will devise a new plan for addressing it.