The majority of patients with lung cancer will be treated with radiation therapy at some point in the course of their treatment. Most early stage patients will be treated with surgery with or without chemotherapy. However, certain early stage lung cancer patients are not candidates for surgery and thus would be treated with radiation therapy. The majority of locally advanced patients with lung cancer will require radiation, while metastatic (stage IV) patients may need radiation as a palliative measure (to relieve symptoms such as cough, shortness of breath, pain, or bleeding).
Early Stage Lung Cancer
Surgery is typically the first line of treatment for early-stage lung cancer but radiation is now often used as a curative treatment for stage I and II lung cancer in both operable and non-operable patients. External radiation has been used in the past with modest results, although not curing patients at the same rate as surgery. An advanced technology, stereotactic body radiotherapy, has been developed and utilized for early-stage lung cancer with outstanding results. The treatment is typically delivered in 3-5 treatments over the course of 1 – 2 weeks. The cure rates approach those of surgery, while being associated with very limited side effects, including chest wall pain and minor inflammation of the lung. In rare cases, a fistula (abnormal communication) may form in the airway, which would require surgical correction. ARM radiation oncologists are able to treat patients with this technique and can discuss this with you during your consultation.
Locally Advanced Lung Cancer
External radiation is used to treat most stage III cancers, either in the preoperative setting, post-operative setting, or as the curative treatment. If treating preoperatively, patients typically receive combination chemotherapy and radiation for 5 weeks and then the surgeon would re-evaluate to see if surgery is feasible. In other cases, patients are found to have residual disease after surgery or have developed metastatic disease in the mediastinum (middle of the chest). These patients may benefit from a 5 to 5.5 week course of radiation therapy to the tumor bed and mediastinum. Lastly, certain patients will not be candidates for surgery. A combination of radiation and chemotherapy or radiation alone will be used to attempt the cure. Typically, a 6-7 week course of daily radiation is delivered. In select situations (i.e. small cell lung cancer), the treatment may be delivered in a shorter course while being given two times a day.
The acute side effects of radiation therapy include fatigue, redness/irritation and peeling of the skin of the chest and back, temporary worsening of a cough, irritation of the esophagus causing difficulty with swallowing and pain and the need for IV hydration due to irritation of the esophagus, but generally is well tolerated. Your ARM radiation oncologist will see you weekly during treatment to assess your response and manage your side effects. Late side effects could include continued irritation of the skin, narrowing of the esophagus requiring surgical correction, inflammation of the lung leading to a cough and shortness of breath requiring steroids, persistent inflammation leading to scar tissue formation that compromises breathing and necessitates supplemental oxygen or ventilation, and extreme scarring of the lung leading to death. This is why follow-up with your ARM radiation oncologist will be essential.
Metastatic Lung Cancer
When lung cancer has spread outside of the lung and mediastinum, it is usually not curable, but it is treatable. Oftentimes the tumor can cause shortness of breath, chest pain, persistent coughing, and bleeding, as well as bone pain. It can also spread to the brain causing neurologic side effects such as headaches, motor weakness, seizures, speech changes, and other stroke-like symptoms. In these situations, palliative radiation can be used to treat the symptoms of the disease. It is very effective in relieving symptoms and is delivered in a short course, typically over 1 to 3 weeks, and sometimes in just one dose. During your consultation with your ARM radiation oncologist, be sure to explain all the symptoms you are having from your illness, to see if there is anything else they can help with.