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Radiation for Lung Cancer: What To Expect and Side Effects

Posted on August 18, 2022
Medically reviewed by
Mark Levin, M.D.
Article written by
Maureen McNulty

What Is Radiation Therapy? | Who Gets Radiation Treatment? | What It’s Like | Side Effects | Get Support

Many people use radiation therapy as a part of their lung cancer treatment plan. Radiation therapy can have several purposes, including:

  • Getting rid of tumors
  • Shrinking a tumor before surgery to make it easier to remove
  • Killing (sterilizing) any cancer cells left behind after surgery
  • Treating metastases (lung cancer cells that have spread to other parts of the body) that are causing symptoms
  • Relieving lung cancer symptoms

What Is Radiation Therapy?

Radiation treatments use high-energy rays or particles to kill cancer cells. These particles damage a cell’s DNA (the material in a cell that contains genes). If too much damage builds up, the cell dies.

Radiation is more likely to affect cells that are growing and producing new cells. For this reason, quickly dividing cancer cells are more likely to die following radiation than surrounding healthy cells.

Types of Radiation Therapy

There are different types of radiation treatments. Some are external: They use a machine located outside of the body to deliver beams or particles to a tumor. Other types are internal: They involve placing a radioactive substance within the body near the tumor.

Types of External Radiation Therapy

External beam radiation therapy (EBRT) is the most common type of radiation therapy. During this procedure, a large machine aims high-energy X-rays at the cancer cells. The beams are usually directed from opposing sides so that the surrounding tissue gets less radiation.

Other types of radiation that are used to treat lung cancer include stereotactic body radiation therapy (SBRT) and stereotactic radiosurgery (SRS). These techniques use many small beams of radiation aimed at the tumor from multiple angles. SRS is sometimes used to treat metastases in the brain instead of whole-brain radiation.

Some hospitals may use newer techniques, such as three-dimensional conformal radiation therapy or intensity-modulated radiation therapy. These types of radiation therapy use imaging tests to get a clearer view of where the tumor is. They often create less damage to the surrounding normal tissues.

Internal Radiation Therapy

Brachytherapy delivers radiation to the body with radioactive substances rather than machines. With brachytherapy, doctors use surgery to place small radioactive “seeds” or a plastic tube containing radioactive material directly into the lung or airway. These substances give off radiation that kills the nearby cancer cells but spares cells that are a little farther away. Most often, brachytherapy is used to treat symptoms, such as a lung tumor blocking the airway.

Who Gets Radiation Treatments?

Radiation therapy is used to treat both non-small cell lung cancer (NSCLC) and small cell lung cancer (SCLC). The treatment options available to a person are based on factors like the type of lung cancer, the size and location of the tumor, and the lung cancer stage (how far the cancer has spread).

Radiation Therapy for NSCLC

Early-stage lung cancer is usually treated with surgery. This includes stage 1 and stage 2 NSCLC, where the cancer has not yet spread outside of the lungs. Surgery may be followed by radiation or chemotherapy treatments to kill any cancer cells that still exist. Some people, including elderly adults or people with heart failure, may not be able to receive surgery. In this case, doctors may recommend SBRT as the main treatment plan.

People with stage 3 NSCLC often first receive chemotherapy and radiation therapy to shrink their tumor. In some cases, doctors may then recommend surgery to remove the rest of the cancer. Some people may not be healthy enough to undergo chemotherapy treatments and surgery. In this case, radiation treatments are given on their own.

People with stage 4 NSCLC have cancer that has spread to one or more places around the body. Radiation treatments may be able to help treat symptoms caused by these metastases, but they will likely not cure the cancer. Other treatments may be given along with radiation therapy, including chemotherapy, surgery, and targeted therapy.

Radiation Therapy for SCLC

Surgery is usually not a good fit for people with SCLC, because the cancer usually can’t be easily removed or has spread. Many people with limited-stage SCLC, which is cancer that is located only within the lung, receive radiation therapy to the lung and chemotherapy. People who aren’t healthy enough for aggressive treatments may receive chemotherapy first, followed by radiation.

Extensive-stage SCLC has metastasized around the body. People with this condition don’t usually receive radiation as a first treatment. However, they may receive it later if chemotherapy and immunotherapy drugs successfully shrink the tumor. Radiation therapy can also be used to treat symptoms in people with extensive-stage lung cancer.

Cancer metastasizes to the brain for about half of people with SCLC. Doctors may administer prophylactic (preventive) radiation treatments to the brain to help reduce the chances that lung cancer will spread there. This is called prophylactic cranial irradiation.

What Is It Like To Get Radiation Therapy?

Specialized doctors called radiation oncologists oversee radiation treatments. The treatments themselves may be delivered by other medical professionals, including radiation physicists, dosimetrists, radiation therapists, and radiation therapy nurses.

People receive radiation treatments over the course of multiple sessions. Each session usually takes a few minutes.

EBRT sessions for NSCLC usually take place five days per week and may last between five and seven weeks.

Treatments for SCLC are usually once or twice per day for three to seven weeks, although the treatment schedule may be shorter if radiation is being used to treat symptoms.

SBRT may only require one to five treatment sessions. Radiation oncologists may recommend an individualized treatment plan depending on your particular case.

Your first radiation session does not include actual treatment. It is a practice session called a simulation. During the simulation, the radiation therapy team will use imaging tests to determine where the tumor is and plan where the radiation should be delivered. It is important that the radiation beams are aimed at the exact right spot. The radiation team may prepare blocks, sponges, headrests, casts, or molds to help ensure that your body is positioned correctly during each session or to shield other organs.

During brachytherapy, radioactive substances are placed in the body. Doctors may give you anesthesia to numb pain or put you to sleep. Once the treatment is in place, you may have to follow certain precautions, such as staying away from children or pregnant women.

Radiation therapy doesn’t hurt. The particles or X-rays used during this treatment pass right through the skin and other tissues, and you can’t feel them.

Side Effects of Radiation Therapy

Radiation treatments can cause complications or lead to other health problems. Some of these side effects appear quickly following radiation therapy. Others may not appear until months or years later. Managing these side effects is an important part of cancer treatment.

Short-Term Side Effects

Although radiation therapy targets cancer cells, the body’s normal cells can be killed as well. Damage to the healthy tissue near the treatment area can lead to several side effects, including:

  • Skin changes such as discoloration or peeling
  • Hair loss
  • Tiredness
  • Sore throat
  • Swallowing problems
  • Coughing
  • Shortness of breath
  • Nausea or vomiting
  • Loss of appetite
  • Headaches, confusion, or memory problems

Many of these side effects disappear once treatment is finished. However, some of them may linger after radiation therapy is complete.

Long-Term Side Effects

Radiation therapy for lung cancer sometimes leads to future health problems. Radiation treatment can damage the heart and lungs. People who undergo radiation treatments to the middle of the chest are more likely to develop heart disease. This may include an irregular heartbeat, stiffened arteries, or damage to the heart valves.

Radiation therapy may also cause radiation pneumonitis (inflammation of the lungs), leading to chest pain and breathing problems. Additionally, radiation may cause scar tissue to build up in the lungs, making it harder to take full breaths.

Radiation treatments can also cause additional cancers to develop years later. However, most people who undergo radiation do not develop a second cancer. Usually, the benefit of radiation therapy outweighs potential risks.

Treating Side Effects From Radiation Therapy

If you are experiencing radiation therapy side effects, talk to your doctor. They may be able to prescribe medications to help you feel better. You can also ask for palliative care services. This type of care aims to reduce cancer symptoms and treatment side effects. Palliative care can be used during any stage of treatment, and it can be used along with curative treatments.

You may have to make some changes in order to deal with possible side effects. Several strategies may help you cope and stay healthy during treatment, including:

  • Treating skin in the affected area with products that contain aloe or lanolin and protect against sunburn
  • Going to bed earlier or napping more frequently to reduce fatigue
  • Eating a balanced diet containing more vitamins and minerals and fewer greasy or spicy foods
  • Choosing softer foods if you have trouble with mouth sores or swallowing
  • Eating multiple smaller meals if you don’t have much appetite
  • Getting physical activity if you can handle it — Even a short walk can help support physical and mental health.
  • Protecting against infection by washing your hands, wearing a mask, and staying away from people who are sick
  • Practicing deep breathing exercises or relaxation techniques
  • Talking to family, friends, or a mental health professional if you are struggling with anxiety or depression.
  • Telling your doctor right away if you notice a rash, pain, breathing problems, or tightness in the chest

Talk to your cancer care team if side effects are preventing you from doing your usual activities. Although some side effects are normal and expected, your doctor may want to change your treatment plan if side effects are becoming severe.

Talk With Others Who Understand

MyLungCancerTeam is the social network for people with lung cancer and their loved ones. On MyLungCancerTeam, more than 6,700 members come together to ask questions, give advice, and share their stories with others who understand life with lung cancer.

Are you using radiation therapy to treat your lung cancer? Share your experience in the comments below, or start a conversation by posting on your Activities page.

All updates must be accompanied by text or a picture.
Mark Levin, M.D. is a hematology and oncology specialist with over 37 years of experience in internal medicine. Review provided by VeriMed Healthcare Network. Learn more about him here.
Maureen McNulty studied molecular genetics and English at Ohio State University. Learn more about her here.

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