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Radiotherapy for non small cell lung cancer

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This page tells you about radiotherapy for non small cell lung cancer (NSCLC). There is information about

 

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Radiotherapy for non small cell lung cancer

For early stage cancer your doctor may suggest radiotherapy instead of surgery to try to get rid of the cancer cells. This is called radical radiotherapy. 

Your doctor may suggest this if you can't have an operation. This could be due to a medical condition such as heart failure or lung disease. It may be the best treatment if the cancer is close to your heart or in an awkward place in the lung. This would make surgery a difficult option. Some people may have radiotherapy after chemotherapy or surgery.

There are different treatment plans for radical radiotherapy. A plan called CHART means you stay in hospital or a hostel nearby and have 3 treatments each day for 2 weeks (12 days), including the weekend. 

One plan involves having 1 treatment each day from Monday to Friday, for between 4 and 7 weeks. Some people have targeted radiotherapy (stereotactic radiotherapy) 3 to 5 times over 2 weeks for small tumours on the outer part of the lung. You have these treatments as an outpatient.

Chemotherapy and radiotherapy together

Doctors sometimes give chemotherapy and radiotherapy together. This can help the treatment to work better. Some people have chemotherapy followed by radiotherapy (sequential treatment). 

Some people have both treatments together and it is called concomitant chemoradiotherapy. Concomitant chemoradiotherapy causes more severe side effects than having the treatments separately so you need to be quite fit to have it.

Radiotherapy to improve lung cancer symptoms

If you have chest pain or a troublesome cough, you may have radiotherapy to help control your symptoms. Radiotherapy can also reduce pain if cancer cells have spread into the bone. You may have 1 treatment only, 2 treatments about a week apart, or a course of treatment over about 2 weeks.

 

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Radical radiotherapy

Surgery is the most common treatment for stages 1, 2 and 3 non small cell lung cancer and is sometimes followed by chemotherapy. But your doctor may suggest that you have radiotherapy instead of surgery to try to get rid of the cancer cells. This is called radical radiotherapy and your doctor may suggest it if one or more of the following applies to you

  • You can't have an operation due to a medical condition such as heart failure or chronic lung disease
  • You have stage 3 cancer and the tumour is close to your heart
  • The cancer is in an awkward place in the lung and surgery would be too difficult (an inoperable tumour)

Radiotherapy is often used for cancers that grow right at the top of the lung. These tumours can be very close to the nerves that supply the arm and are difficult to operate on. They are called pancoast tumours. The radiotherapy may be followed by chemotherapy. Sometimes this makes it possible to remove the tumour with surgery afterwards.

 

Having radical radiotherapy

There are different ways of giving radical radiotherapy treatment. One way means that you stay in hospital (or a patient hostel) and have 3 treatments each day – 6 hours apart – for 3 weeks, including weekends. This is called CHART (Continuous Hyperfractionated Accelerated Radio Therapy – CHART). 

Another way gives 1 treatment each day, for between 4 to 7 weeks. You have this radiotherapy from Monday to Friday as an outpatient. You may need to travel to the hospital each day or stay in a patient hostel. The dose of radiation with both ways of giving radiotherapy is about the same. Some research has shown that in some people CHART works better than having single daily radiotherapy treatments.

Government guidelines for lung cancer say that CHART should be offered to people needing radical radiotherapy who have

  • Stage 1 or 2 NCSLC and can't have surgery
  • Stage 3A or 3B NSCLC and are not fit enough to have chemoradiotherapy

For small tumours on the outer part of the lung, some people have targeted radiotherapy (stereotactic radiotherapy) 3 to 5 times over 2 weeks.

A clinical trial is currently looking into whether Intensity Modulated Radiotherapy (IMRT) is a better option for patients who can't have surgery. For this trial patients have treatment twice a day. IMRT targets cancer cells whilst sparing healthy tissues from radiation. This trial is still underway and waiting for results.

 

Radiotherapy and chemotherapy together

Doctors sometimes give chemotherapy at the same time as radiotherapy. Having chemotherapy and radiotherapy together is called concomitant chemoradiotherapy or concurrent chemoradiotherapy. 

Having the treatments together increases the side effects and you need to be quite fit and well to have this treatment. But if you have stage 2 or 3 non small cell lung cancer and are well enough your doctor may suggest it to you. You may have this treatment as part of a clinical trial.

 

Radiotherapy after chemotherapy

You may have chemotherapy followed by radiotherapy for stage 3 lung cancers. This is where the cancer has spread into the lymph nodes on the opposite side of the chest from the tumour. Chemotherapy followed by radiotherapy is called sequential treatment.

 

Radiotherapy after surgery

Having radiotherapy after surgery can slightly reduce the chance of the cancer coming back in the lung for some people with early stage lung cancer. This is called adjuvant radiotherapy. 

You usually only have radiotherapy if your surgeon has not been able to completely remove the cancer. Or you may have it if your surgeon found cancer cells in the lymph nodes close to the lung.

A clinical trial called LungART is currently looking into whether radiotherapy after surgery for non small cell lung cancer will help stop the cancer from coming back. This trial is still in progress.

 

Radiotherapy to improve lung cancer symptoms

If you have chest pain or a troublesome cough, you may have radiotherapy to help control your symptoms. It can also help if you are coughing up blood and reduce pain if cancer cells have spread into the bone. You can have this treatment in different ways;

  • 1 treatment only
  • 2 treatments about a week apart
  • A course of treatment over a week
  • A course of treatment over about 2 weeks

A review of clinical trials in radiotherapy for lung symptoms was completed. It showed that in most patients, shorter courses of 1 or 2 symptoms were just as good at relieving symptoms. These symptoms included coughing and chest pains. They also found that short courses also give fewer side effects.

The total dose of radiation is larger in 1 or 2 treatments compared to a course of treatment over 2 weeks. Each individual dose of radiation is smaller because there are more treatments (about 10 instead of 1 or 2). Sometimes it is better to have treatment over 2 weeks if the doctor thinks a longer course may be helpful in your case.

For some fitter patients, a longer course of radiotherapy may help to control the cancer for longer. But the longer course also gives more short term side effects, especially soreness and swallowing.

 

For more information

Find out about

Radiotherapy

Surgery for lung cancer

Chemotherapy for lung cancer

Stages 1, 2 and 3 for non small cell lung cancer

Pancoast tumours

Clinical trials

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Updated: 28 March 2014