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Radiation therapy is the use of high-energy rays (such as x-rays) or radioactive particles to kill cancer cells.
Surgery is the main treatment for most carcinoid tumors, but radiation therapy may be an option for those who can’t have surgery for some reason. It may also be given after surgery in some cases if there’s a chance some of the tumor was not removed. Radiation therapy can also be used to help relieve symptoms such as pain if the cancer has spread to the bones or other areas.
External beam radiation therapy uses a machine that delivers a beam of radiation to a specific part of the body. This is the type of radiation used most often for lung carcinoid tumors.
Before your treatments start, the radiation team will 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, but the setup time – getting you into place for treatment – usually takes longer. Most often, radiation treatments are given 5 days a week for several weeks, but this can vary based on the reason it’s being given.
The main side effects of lung radiation therapy are fatigue (tiredness) and temporary sunburn-like skin changes where the radiation passed through the skin. If high doses are given, radiation therapy can cause scar tissue to form in the lungs over time, which might lead to trouble breathing and an increased risk of pneumonia.
Another type of radiation therapy uses drugs containing radioactive particles. This type of treatment is called peptide receptor radionuclide therapy (PRRT) and may be useful in treating some widespread carcinoid tumors. Lutetium (Lu-177) dotatate (Lutathera®) is a PRRT that has been approved for patients with gastrointestinal and pancreatic neuroendocrine tumors, but can also be considered for some lung carcinoid tumors that have the somatostatin receptor. Lu-177 is a radioactive substance. It is carried to the cancer cells by dotatate where it attaches to carcinoid tumor cells. This lets doctors deliver high doses of radiation directly to the tumors. It is given as an infusion into a vein (IV).
The most common side effects are nausea, kidney and liver problems, low white blood counts, low platelet counts, and vomiting.
Since this therapy involves radiation that is injected into the bloodstream, you will be given special instructions on how to minimize the radiation exposure during and after treatment.
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Fazio N, Ungaro A, Spada F, et al. The role of multimodal treatment in patients with advanced lung neuroendocrine tumors. Journal of Thoracic Disease. 2017;9(Suppl 15):S1501-S1510. doi:10.21037/jtd.2017.06.14.
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National Comprehensive Cancer Network. NCCN Clinical Practice Guidelines in Oncology: Neuroendocrine and Adrenal Tumors. V.2.2018. Accessed at https://www.nccn.org/professionals/physician_gls/pdf/neuroendocrine.pdf on July 11, 2018.
Thomas CF, Jett JR, Strosberg JR. Lung neuroendocrine (carcinoid) tumors: Treatment and prognosis. UpToDate website. https://www.uptodate.com/contents/lung-neuroendocrine-carcinoid-tumors-treatment-and-prognosis. Updated Feb. 6, 2018. Accessed July 17, 2018.
Last Revised: August 28, 2018