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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 it if you can't have an operation due to a medical condition such as heart failure or lung disease. Or it may be the best treatment if the cancer is close to your heart or in an awkward place in the lung and surgery would be too difficult. 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 3 weeks, including at weekends. 

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 chemoradiation. Concomitant chemoradiation 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. 

We have detailed information about pancoast tumours.

 

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, 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

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

 

Radiotherapy and chemotherapy together

Doctors sometimes give chemotherapy at the same time as radiotherapy. Having chemotherapy and radiotherapy together is called concomitant chemoradiation or concurrent chemoradiation. 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. Or 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 where the cancer has spread into 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.

 

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 it can 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 about 2 weeks

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.

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.

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.

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 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.

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Updated: 28 March 2014