Lung Cancer

RADIATION THERAPY

Typical Course

Radiation therapy for lung cancer is given in small fractions, once or twice a day for five to eight weeks. From the patient’s standpoint, each daily treatment is relatively simple. The patient lies on the treatment table and the machine administers a one-minute treatment through each of several radiation ports. No immediate sensation occurs with these radiation treatments.

From the radiation oncologist’s point of view, the treatment of lung cancer is quite complex. Special computerized equipment is used to direct the beams to maximize doses to the cancer. Great care is taken to minimize the dose regarding uninvolved lung tissue, heart, and other critical structures in the chest such as the spinal cord.

Brachytherapy

A recent advance in the treatment of lung cancer is so-called internal radiation or “brachytherapy.” The patient’s pulmonologist introduces a small, plastic catheter through the patient’s nose, down the trachea and into the involved portion of the lung. This is done with a bronchoscope. The bronchoscope is then removed and a plastic catheter is secured to the nostril with tape. During the next half hour or so radiation planning and treatment is provided via the plastic tube using a nucletron machine. This machine introduces a small radioactive pellet into the catheter, giving concentrated radiation to a small spot within the lung. The catheter is then removed and the patient goes home the same day.

Side-effects

The side effects of radiation can divided into two separate categories. The first category involves short-term reactions, which occur during or shortly after radiation therapy. The second category involves chronic side effects, which can develop years after the radiation is finished.

The short-term side effects of radiation to the chest can include irritation of the food pipe (esophagus) and to the airways. Patients can experience some sore throat or difficulty swallowing. They may also develop a cough. These symptoms usually do not occur until the second or third week of radiation. There are medicines that are moderately effective in controlling these side effects. Usually the side effects dissipate within a few weeks after the radiation ends.

Another short-term side effect that some patients experience is fatigue. An extra nap each day along with light exercise often helps.

The most severe chronic side effect from radiation in this region is damage to the spinal cord. The radiation oncologist takes great care to avoid this side effect by minimizing, to the greatest extent possible, the amount of radiation to the spinal cord. By carefuling using precise techniques, this risk of damage is less than 1%. Damage to the spinal cord is devastating and can lead to paralysis, but it is very rare. When compared to the risk of progressive cancer, this risk is considered acceptable by most patients.

Another risk of radiation therapy is damage to the normal (uninvolved) lung. The radiation oncologist will take care to control the dose to the uninvolved lung as much as possible. However, the tumor and its draining lymph nodes are adjacent to normal lung tissue and it is not possible to shield these “good cells” altogether. Great care is taken to minimize radiation to the uninvolved lung and in the overall balance, the benefits of the radiation outweigh the risks.

Diet

A good diet is very important when a patient is being treated for lung cancer. Food needs to be palatable and nutritious. It is best to stay away from spicy or fatty foods. Sometimes, soft food is helpful, especially if esophagitis develops.

Please see the separate section in this website about nutrition.