Lung Cancer (Non-Small Cell)

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Treating Lung Cancer - Non-Small Cell TOPICS

Radiation therapy for non-small cell lung cancer

Radiation therapy uses high-energy rays (such as x-rays) or particles to kill cancer cells. There are 2 main types of radiation therapy – external beam radiation therapy and brachytherapy (internal radiation therapy).

External beam radiation therapy

External beam radiation therapy (EBRT) focuses radiation from outside the body on the cancer. This is the type of radiation therapy most often used to treat a primary lung cancer or its spread to other organs.

Before your treatments start, the radiation team will take careful measurements to determine the correct angles for aiming the radiation beams and the proper dose of radiation. Treatment is much like getting an x-ray, but the radiation dose is stronger. The procedure itself is painless. Each treatment lasts only a few minutes, although the setup time – getting you into place for treatment – usually takes longer. Most often, radiation treatments to the lungs are given 5 days a week for 5 to 7 weeks, but this can vary based on the type of EBRT and the reason it’s being given.

Standard (conventional) EBRT is used much less often than in the past. Newer techniques help doctors treat lung cancers more accurately while lowering the radiation exposure to nearby healthy tissues. These techniques may offer better success rates and fewer side effects. Most doctors now recommend using these newer techniques when they are available.

Three-dimensional conformal radiation therapy (3D-CRT): 3D-CRT uses special computers to precisely map the location of the tumor(s). Radiation beams are shaped and aimed at the tumor(s) from several directions, which makes it less likely to damage normal tissues.

Intensity modulated radiation therapy (IMRT): IMRT is an advanced form of 3D therapy. It uses a computer-driven machine that moves around you as it delivers radiation. Along with shaping the beams and aiming them at the tumor from several angles, the intensity (strength) of the beams can be adjusted to limit the dose reaching the most sensitive normal tissues. This technique is used most often if tumors are near important structures such as the spinal cord. Many major hospitals and cancer centers now use IMRT.

Stereotactic body radiation therapy (SBRT): SBRT, also known as stereotactic ablative radiotherapy (SABR), is sometimes used to treat very early stage lung cancers when surgery isn’t an option due to issues with a patient’s health or in people who do not want surgery.

Instead of giving small doses of radiation each day for several weeks, SBRT uses very focused beams of high-dose radiation given in fewer (usually 1 to 5) treatments. Several beams are aimed at the tumor from different angles. To target the radiation precisely, you are put in a specially designed body frame for each treatment. This reduces the movement of the lung tumor during breathing. Like other forms of external radiation, the treatment itself is painless.

Early results with SBRT for smaller lung tumors have been very promising, and it seems to have a low risk of complications. It is also being studied for tumors that have spread to other parts of the body, such as the bones or liver.

Stereotactic radiosurgery (SRS): SRS is a type of stereotactic radiation therapy that is given in only one session. It can sometimes be used instead of or along with surgery for single tumors that have spread to the brain. In one version of this treatment, a machine called a Gamma Knife® focuses about 200 beams of radiation on the tumor from different angles over a few minutes to hours. Your head is kept in the same position by placing it in a rigid frame. In another version, a linear accelerator (a machine that creates radiation) that is controlled by a computer moves around your head to deliver radiation to the tumor from many different angles. These treatments can be repeated if needed.

Brachytherapy (internal radiation therapy)

In people with lung cancer, brachytherapy is sometimes used to shrink tumors in the airway to relieve symptoms. But it is used less often for lung cancer than for other cancers such as head and neck cancers.

For this type of treatment, the doctor places a small source of radioactive material (often in the form of small pellets) directly into the cancer or into the airway next to the cancer. This is usually done through a bronchoscope, but it may also be done during surgery. The radiation travels only a short distance from the source, limiting the effects on surrounding healthy tissues. The radiation source is usually removed after a short time. Less often, small radioactive “seeds” are left in place permanently, and the radiation gets weaker over several weeks.

When is radiation therapy used?

Radiation therapy might be given at different times, depending on the purpose:

  • As the main treatment of lung cancer (sometimes along with chemotherapy), especially if the lung tumor cannot be removed by surgery because of its size or location, if a person’s health is too poor for surgery, or if a person does not want surgery.
  • After surgery (alone or along with chemotherapy) to try to kill any small deposits of cancer that surgery may have missed.
  • Before surgery (usually along with chemotherapy) to try to shrink a lung tumor to make it easier to operate on.
  • To relieve (palliate) symptoms of advanced lung cancer such as pain, bleeding, trouble swallowing, cough, or problems caused by spread to other organs such as the brain. For example, brachytherapy is most often used to help relieve blockage of large airways by cancer.

Possible side effects of radiation therapy

Common side effects depend on where the radiation is aimed and can include:

  • Fatigue
  • Nausea and vomiting
  • Loss of appetite and weight loss
  • Skin changes in the area being treated, which can range from mild redness to blistering and peeling
  • Hair loss where the radiation enters the body

Often these go away after treatment. When radiation is given with chemotherapy, the side effects are often worse.

Radiation therapy to the chest may damage your lungs and cause a cough, problems breathing, and shortness of breath. These usually improve after treatment is over, although sometimes they may not go away completely.

Your esophagus, which is in the middle of your chest, may be exposed to radiation, which could cause a sore throat and trouble swallowing during treatment. This might make it hard to eat anything other than soft foods or liquids for a while.

Radiation therapy to large areas of the brain can sometimes cause memory loss, headaches, trouble thinking, or reduced sexual desire. Usually these symptoms are minor compared with those caused by a brain tumor, but they can reduce your quality of life. Side effects of radiation therapy to the brain usually become most serious 1 or 2 years after treatment.

For more information, please see the “Radiation Therapy” section of our website or our document Understanding Radiation Therapy: A Guide for Patients and Families.

Last Medical Review: 08/15/2014
Last Revised: 03/04/2015