Radiation therapy for non-small cell lung cancer explained

Explanation

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Cancer develops when some of the cells in a person’s body grow and divide in an unusual and uncontrolled way. This can lead to formation of tumors, which are large lumps of organic tissue. When tumors develop within an organ, this may cause organ damage and infection, which can be fatal.

Lung cancer occurs when these cells divide and grow in the lungs. In the later stages of lung cancer, however, the cancerous cells begin to spread around the body. People with untreated lung cancer will eventually develop tumors in other organs, such as the brain, liver, or kidneys.

Radiation therapy works by directing high doses of radiation toward cancer cells. When a person receives this therapy over a period of time, the radiation should damage the cancer cells’ DNA. Eventually, this will often kill the cancer cells or stop them from multiplying.

Internal vs. external

There are two main kinds of radiation therapy. External radiation therapy is when doctors use a machine to direct radiation into a person’s body from the outside. This works similarly to an X-ray, although it uses much higher doses of radiation.

By contrast, internal radiation therapy is when doctors place a source of radiation directly into a person’s body.

Types

The American Cancer Society notes that only some types of radiation therapy are appropriate for NSCLC. Doctors may use these radiation therapies on their own or alongside other cancer treatments.

Stereotactic body radiation therapy

Stereotactic body radiation therapy (SBRT), also known as stereotactic ablative radiotherapy, is a form of external radiation therapy. Doctors use SBRT when a person’s health prevents them from undergoing a surgical procedure.

Radiation therapy often takes a long time, with individuals receiving several doses of radiation over days or even weeks. However, SBRT works differently, by providing fewer but stronger doses of radiation.

This radiation is harmful to healthy cells too, which is why it is very important for doctors to aim the radiation very precisely. An individual who receives SBRT must enter a special body frame for each session. This limits their movements, which makes it less likely that the radiation accidentally damages healthy cells.

Authors of a 2014 review conclude that patients were able to tolerate complications of SBRT. They also describe this treatment as “relatively effective, convenient, and tolerable” for recurrent tumors.

3D conformal radiation therapy

3D conformal radiation therapy (3D-CRT) is a sophisticated form of external radiation therapy.

With 3D-CRT, doctors can use computers to create a precise map of a tumor’s location. They then use this map to point several different radiation beams at the cancer while controlling the shapes of the beams.

The beams are coming from different locations, and it is therefore less likely that 3D-CRT will damage healthy tissues.

Intensity modulated radiation therapy

Intensity modulated radiation therapy (IMRT) is a different form of external 3D radiation therapy.

As with 3D-CRT, doctors can use IMRT to control the shape and direction of the radiation beams. However, with IMRT, doctors can also control the strength of each beam. This makes IMRT very useful for treating tumors that are near important body parts, such as the spine.

There is also a version of IMRT called volumetricmodulated arc therapy (VMAT). VMAT allows doctors to deliver radiation doses very quickly, which makes for a faster treatment.

Stereotactic radiosurgery

Despite its name, stereotactic radiosurgery (SRS) is not a form of surgery but another type of external radiation therapy. Doctors typically use SRS to treat single brain tumors.

One common version of SRS uses a machine to aim around 200 beams of radiation at the tumor, all from different angles. In a different version of SRS, a machine keeps moving around a person’s head, directing a single beam of radiation toward the tumor.

SRS can take from several minutes to several hours. Unlike with other forms of external radiation therapy, doctors only recommend one session of SRS per SRS therapy.

Brachytherapy

Brachytherapy is a type of internal radiation therapy. Doctors use it to shrink the tumors in a person’s airways. This can help relieve the symptoms of NSCLC.

With brachytherapy, a doctor will place a small quantity of solid radioactive material near a person’s tumor. Doctors can do so with surgery, although they most often use a bronchoscope.

With this flexible tube, doctors can look into a person’s airways using a tiny camera and deposit the radioactive material where needed.

After leaving the radioactive material in the body for some time, doctors will often remove it. In some cases, however, doctors use a weaker radioactive source, which can stay in the body indefinitely.

Effectiveness

Many doctors recommend some form of radiation therapy to treat NSCLC. However, the effectiveness of these therapies can depend on the stage of a person’s cancer.

For example, according to a 2020 review, radiation therapy is not particularly useful for treating early stage NSCLC. Doctors only recommend it when a person with early stage NSCLC cannot undergo surgery or if they have other serious health conditions alongside NSCLC.

Nonetheless, there is evidence that radiation therapy can be an effective treatment for NSCLC. A 2019 study looked at 288,670 people with NSCLC, at all stages of the condition. The authors report that those people who had received radiation therapy had a higher survival rate than those who had not.

A person should consider the different treatment options and their pros and cons with a doctor.

Managing side effects

Like many cancer treatments, radiation therapy can produce side effects. To manage these, a person may wish to consider the following techniques:

Fatigue

People who experience fatigue after radiation therapy can try:

• creating a plan with a good rest-to-activity ratio
• eating a balanced diet
• meeting with a mental health professional to address the emotional consequences of cancer treatment

Learn about foods that can help with fatigue here.

Nausea and vomiting

Radiation therapy may cause a person to experience nausea or vomiting. According to the National Cancer Institute (NCI), the following may help with these side effects:

• using antiemetic medication
• drinking plenty of fluids
• avoiding foods that increase feelings of nausea

The NCI especially recommends following these steps on treatment days.

Learn 17 home remedies for nausea and vomiting here.

Skin problems

Radiation therapy can cause mild skin problems. For example, a person may notice dry or peeling skin. The skin may also change color, swell, or develop sores.

The NCI recommends the strategies below to help reduce or treat these problems:

• using only mild skin products
• moisturizing the skin
• protecting the skin from the sun

Learn about home remedies for dry skin here.

Hair loss

Radiation therapy can cause hair loss on the part of the body toward which doctors direct the rays.

To address hair loss, the NCI suggests:

• treating the hair gently
• using a mild shampoo
• protecting the scalp from the sun

Learn how to help treat hair loss here.

Summary

Doctors have developed many sophisticated types of radiation therapy that can improve the length and quality of life for those with NSCLC and may even cure some people’s NSCLC.

Side effects of radiation therapy include nausea and vomiting, skin problems, and tiredness. However, there are several ways a person can reduce the severity of these side effects.