Radiotherapy for non small cell lung cancer

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. There is detailed information about pancoast tumours in the lung cancer questions section.

There are two 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, so 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 chemoradiation

If you are offered daily radiotherapy you can ask your cancer specialist about CHART. At the moment, it is not available everywhere but your doctor may be able to refer you to a hospital that provides it.

Doctors sometimes give chemotherapy along with radiotherapy. Chemotherapy and radiotherapy together are called chemoradiation. Having the treatments together increases the side effects and not everyone is fit enough for 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. Or you may have chemoradiation as part of a clinical trial.

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

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 the cancer has been completely removed with surgery. Or if during surgery the surgeon finds cancer cells in the lymph nodes close to the lung.

Radiotherapy is very good at controlling chest symptoms such as pain and coughing. It can also reduce pain if the cancer cells have spread into the bone. This type of radiotherapy treatment may be given in different ways

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

Different ways of giving treatment are good for different circumstances. How you have the treatment depends on your individual needs. Usually 1 or 2 treatments are best because there is less travelling for you and a lower chance of side effects. Side effects are more likely with a longer course of treatment, but are nearly always only temporary.

With a course of treatment over 2 weeks, the total dose of radiation is larger than with 1 or 2 treatments. But 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.

A 2006 Cochrane review of clinical trials into radiotherapy for lung cancer symptoms showed that in most people shorter courses of 1 or 2 treatments are just as good at relieving symptoms such as coughing or chest pain as longer courses. Short courses also give fewer side effects. 

For some fitter patients, a longer course of radiotherapy may give a slightly better chance of living for 1 or 2 years. But the longer course also gives more short term side effects, especially soreness on swallowing. You can read this review of radiotherapy for controlling symptoms of non small cell lung cancer in the Cochrane Library. It was written for researchers and specialists so is not in plain English.