Radiotherapy for Lung Cancer: Types, Success Rate, Side Effects And More

Radiotherapy for lung cancer is a common and effective treatment that uses high-energy beams to destroy or stop the growth of cancer cells, and there are various types and advancements in radiation treatment for lung cancer that aim to precisely target the disease while minimizing side effects.

What is Radiotherapy for Lung Cancer?

Radiation for lung cancer, also known as radiotherapy treatment for lung cancer, is a medical procedure that utilizes high-energy X-rays or other types of radiation beams to specifically target and destroy cancer cells or prevent them from multiplying within the lungs. The primary role of radiotherapy is to deliver a precise dose of radiation to the cancerous tissue, damaging its DNA and leading to cell death, while aiming to minimize harm to the surrounding healthy cells.

Modern radiation techniques are designed to be highly targeted, often using advanced imaging to pinpoint the exact location and shape of the tumor.

Radiotherapy for lung cancer serves different goals: curative aims to eliminate the cancer, often as a primary treatment for early-stage or inoperable cases, sometimes with chemotherapy; adjuvant is supplementary, given after surgery to kill remaining cells or before surgery to shrink tumors; and palliative focuses on relieving symptoms and improving quality of life in advanced cancer.

Types of Radiotherapy for Lung Cancer

There are several key types of radiotherapy for lung cancer. External beam radiotherapy (EBRT) is the most common, where a machine outside the body directs radiation beams at the tumor, typically over several weeks in daily sessions called fractions. Advanced techniques within EBRT, such as Intensity-Modulated Radiation Therapy (IMRT) and Volumetric Modulated Arc Therapy (VMAT), allow for more precise shaping and delivery of radiation. Stereotactic body radiotherapy (SBRT) is a specialized type of EBRT that delivers very high doses of radiation to small, well-defined tumors in the lung in a few treatment sessions.

External Beam Radiation Therapy (EBRT) for Lung Cancer

External beam radiotherapy (EBRT) is the most common approach, where a machine outside the body directs radiation beams at the tumor, typically over several weeks in daily sessions called fractions. Advanced techniques within EBRT, such as Intensity-Modulated Radiation Therapy (IMRT) and Volumetric Modulated Arc Therapy (VMAT), allow for more precise shaping and delivery of radiation.

Stereotactic Body Radiotherapy (SBRT) for Lung Cancer

Stereotactic body radiotherapy (SBRT) is a specialized type of EBRT that delivers very high doses of radiation to small, well-defined tumors in the lung in a few treatment sessions. It’s often used for early-stage lung cancer when surgery is not an option and utilizes advanced imaging and delivery systems for accuracy.

A 2024 population-based study by Ashworth et al., published in Radiotherapy and Oncology, examined the management of stage I NSCLC in Ontario (2010-2019). The study found an increase in Stereotactic Ablative Body Radiotherapy (SABR) utilization from 7.5% to 24.4%, while surgery decreased from 63.8% to 49.9%. Over this period, 2-year Cancer-Specific Survival (CSS) improved for all stage I patients (81.9% to 85.0%) and those surgically managed (92.1% to 95.7%), but remained stable for patients receiving SABR, non-SABR curative radiotherapy, and observation. The study also noted substantial practice variation across Ontario health regions.

Proton Therapy

Proton therapy is an advanced form of radiation that uses protons instead of X-rays. Protons can be precisely controlled to release their energy at a specific depth, potentially delivering a higher dose to the tumor while reducing radiation exposure to surrounding healthy tissues and organs. This can be particularly beneficial for tumors located close to critical structures.

A 2010 study by Iwata et al., published in Cancer, evaluated particle therapy (proton and carbon-ion) for 80 patients with stage I NSCLC treated between 2003 and 2007. The 3-year overall survival rate was 75% (IA: 74%; IB: 76%), cause-specific survival was 86% (IA: 84%; IB: 88%), and local control was 82% (IA: 87%; IB: 77%). The study concluded that particle therapy is safe and effective for stage I NSCLC, with only one patient experiencing grade 3 pulmonary toxicity.

How Effective is Radiotherapy for Lung Cancer?

What are the side effects of radiotherapy for lung cancer? While radiotherapy is a crucial treatment for lung cancer, it can result in various side effects that can manifest during or after the course of treatment. The specific side effects experienced and their severity often depend on the location of the tumor being treated and the amount of radiation administered.

A 2021 study by Vigneron et al., published in CHEST, analyzed 379 lung cancer patients requiring unplanned ICU admission between 2007 and 2018, with non-small cell lung cancer being the most common type (75%). The study observed an increase in patients with advanced stage disease and those receiving immunotherapy or targeted therapy over time. ICU admissions linked to drug-related and procedure-related adverse events also increased.

The ICU, hospital, and 1-year mortality rates were 32.2%, 53.3%, and 68.9%, respectively, and did not change significantly during the study period. Factors independently associated with ICU mortality included a poor performance status before admission and the need for invasive or noninvasive mechanical ventilation

Short-Term Side Effects of Radiotherapy for Lung Cancer

Common short-term side effects of radiotherapy for lung cancer include fatigue, which is frequently reported by patients and can persist for several weeks or even months after the treatment concludes. Changes to the skin in the treated area, such as reddening or darkening, similar to a sunburn, are also common and can sometimes become sore.

Some individuals may experience hair loss in the specific area where the radiation is directed. Feeling or being sick (nausea and vomiting) is another potential side effect, which can often be managed with medication. If the radiation targets the chest area, patients might develop a sore throat and difficulty swallowing, particularly if the esophagus is within the treatment field. Changes in appetite, including loss of appetite, are also frequently reported. Some individuals might experience mild chest discomfort or pain in the hours or days following a treatment session.

Long-Term Side Effects of Radiotherapy for Lung Cancer

Longer-term side effects of radiotherapy for lung cancer can also occur. Lung inflammation, also known as radiation pneumonitis, is a potential complication that can develop weeks to months after the completion of radiotherapy. This condition can cause symptoms such as a persistent cough and shortness of breath. While often resolving on its own, radiation pneumonitis may sometimes require medical intervention, such as steroids or oxygen therapy.

In some instances, the lungs may experience lasting damage. Although less common as a long-term effect, issues with swallowing due to esophagitis might persist for some individuals. If radiotherapy is directed towards the brain, there is a possibility of experiencing memory loss, headaches, or trouble thinking, although these are generally less severe than symptoms caused by cancer spreading to the brain. It’s important to note that side effects vary greatly among individuals.

How is Radiotherapy for Lung Cancer Administered?

The administration of radiotherapy for lung cancer involves several key steps. Pre-treatment planning starts with an appointment and a detailed CT scan to map the tumor and surrounding areas. The radiotherapy team determines the precise radiation dose and treatment plan, and markers are placed on the skin (including small tattoos) to guide the treatment. Sometimes, a mask or cushion is used to ensure the patient stays still.

Imaging is crucial throughout the process. CT scans are essential for planning, and imaging may be used before each treatment session to confirm the patient’s position. For tumors affected by breathing, 4D CT scans might be used.

Treatment sessions are typically outpatient procedures. Radiographers help the patient get comfortable on the treatment couch and align the machine using the skin markers. They then leave the room and operate the machine remotely, while monitoring the patient via CCTV and intercom. The treatment is usually painless and lasts only a few minutes, but the patient needs to remain very still.

Post-treatment care focuses on managing potential side effects, such as fatigue and skin irritation. Dietary adjustments might be necessary if swallowing is difficult. Regular follow-up appointments with the oncology team are important to monitor recovery and address any concerns.

source: www.cancercouncil.com.au

How Long Does It Take to See Results?

The provided texts don’t specify an exact timeline for when patients might see noticeable results like tumor shrinkage after starting radiotherapy for lung cancer. However, it’s understood that radiation begins to damage cancer cells shortly after treatment commences, as evidenced by the onset of side effects around a week into therapy in some cases. When radiotherapy is used to shrink tumors before surgery, this process occurs over the course of the radiation treatment period leading up to the operation.

Doctors assess the success of radiation treatment for lung cancer through a combination of follow-up scans and the monitoring of a patient’s symptoms. Regular imaging, such as CT and MRI scans (similar to those used in the planning stages), allows doctors to visualize the tumor and determine if it has shrunk, remained stable, or unfortunately, progressed. A reduction in the size of the tumor on these scans is a key indicator of the treatment’s effectiveness.

Additionally, doctors will closely monitor any symptoms the patient was experiencing before treatment, such as pain, cough, or breathing difficulties. An improvement or resolution of these symptoms can also signify that the radiotherapy has been successful in controlling the cancer or alleviating its effects. The overall goal of radiotherapy, as mentioned in the texts, is to control or eliminate tumors, improve a patient’s prognosis, and relieve cancer-related symptoms, so these factors are all considered when evaluating the outcome of the treatment.

How Many Radiotherapy Sessions for Lung Cancer?

The number of radiotherapy sessions required for lung cancer treatment can vary significantly depending on several factors, including the specific type and stage of the cancer, the chosen radiation technique, and the overall treatment plan devised by the medical team. A common schedule for traditional radiotherapy involves treatment being delivered five days a week for a period of four to seven weeks. This approach typically results in a total of around 20 to 35 individual treatment sessions.

However, there are also other schedules, such as hyperfractionated radiotherapy, where smaller doses are given more frequently, sometimes twice a day for three weeks.

In contrast to these more extended treatment courses, Stereotactic Body Radiotherapy (SBRT) often involves a much shorter duration, typically ranging from just one to ten treatment sessions in total. These SBRT treatments are often given two to three times a week. In some specific situations, such as when treating lung cancer that has spread to the brain, a type of stereotactic radiation therapy called stereotactic radiosurgery (SRS) can even be administered in a single treatment session.

Ultimately, the precise number of radiotherapy sessions for lung cancer will be determined by the individual patient’s needs and the recommendations of their radiation oncology team.

What is Palliative Radiotherapy for Lung Cancer?

Palliative radiotherapy for lung cancer is a treatment approach used primarily for patients with advanced stage 4 lung cancer, where the cancer has spread to other parts of the body. The main goal of this type of radiotherapy is not to cure the cancer, but rather to relieve symptoms and improve the patient’s quality of life.

Here’s how palliative radiation helps with specific symptoms:

• Pain Relief: When lung cancer spreads to areas like the bones, it can cause significant pain. Palliative radiotherapy can be directed to these specific sites of metastasis to shrink the tumors and reduce the pressure on nerves and other structures, thereby alleviating pain.
• Breathlessness: In advanced lung cancer, tumors can grow and press on or obstruct the airways, leading to shortness of breath or breathlessness. Palliative radiotherapy can be used to shrink these tumors, opening up the airways and making it easier for the patient to breathe.
• Coughing: A persistent cough can be a troublesome symptom for many lung cancer patients, especially when tumors are located in or near the airways. Radiotherapy can help to reduce the size of these tumors, which can lead to a decrease in irritation and a reduction in coughing.

In addition to these specific symptoms, palliative radiotherapy can also be used to manage other issues that may arise in radiotherapy for lung cancer stage 4, such as bleeding, difficulty swallowing, or problems caused by cancer spread to organs like the brain. Doctors often use lower doses of radiation in palliative treatment compared to curative treatment to minimize potential side effects while still effectively relieving symptoms.

Life Expectancy After Palliative Radiotherapy for Lung Cancer

A 2023 study by Utsumi et al., published in Cancer Diagnosis and Prognosis, retrospectively examined 38 lung cancer patients with malignant airway obstruction (MAO) who received palliative external beam radiotherapy (EBRT) with a median dose of 37.5 Gy. 1 Responders, defined by airway reopening or improved obstructive pneumonia, had a significantly longer median survival time of 135 days compared to 45 days for non-responders (p=0.03). 1 The 1-year overall survival rate was 18.5% for responders and 0% for non-responders. 2 The study concluded that palliative EBRT might be an important option for non-curative lung cancer patients with MAO

What Are the Costs of Radiotherapy for Lung Cancer?

Information regarding the costs of radiotherapy treatment for lung cancer can vary significantly based on several factors. These can include the type of insurance coverage a patient has, the specific hospital or treatment center where the therapy is administered, the particular type of radiation therapy recommended (such as external beam, SBRT, proton therapy, or brachytherapy), the number of treatment sessions required, and the region or country where the treatment is received.

A 2023 study by Shafiq et al., published in the Journal of Thoracic Oncology, estimated the cost of radiotherapy for lung cancer in Australia (2017-2020), involving 454 patients (22% Stage I-II, 38% Stage III, 37% Stage IV). The average cost per fraction was AUD $327 overall. The average cost for a 5-year local control (LC) benefit was AUD $51,141 and for 5-year overall survival (OS) was AUD $90,481 for stages I-III combined.

For a 1-year benefit in LC and OS for stages I-III, the costs were AUD $10,228 and AUD $18,096, respectively. The study concluded that radiotherapy is an inexpensive treatment option for lung cancer, with the average cost for 1-year benefits being below the accepted benchmark.

To obtain accurate information about the costs of radiotherapy for lung cancer, it is recommended that patients discuss these financial aspects directly with their healthcare provider or the financial department of the hospital or treatment center where they plan to receive care. They can provide specific details about the anticipated treatment costs, how insurance coverage might apply, and whether there are any financial aid options or payment plans available to help manage the expenses associated with radiotherapy for lung cancer.

Chemoradiotherapy Combined Treatment for Lung Cancer

Chemo and radiotherapy together for lung cancer is a frequent treatment strategy. They are often given concurrently for stage 3 non-small cell lung cancer to improve effectiveness, though this can increase side effects. Chemotherapy may also precede or follow radiotherapy. For limited stage small cell lung cancer, they are commonly combined. This combined treatment can be more effective, but it also carries a higher risk of side effects.

Read OncoDaily’s Special Article About Chemoradiotherapy

What Are The Recent Advances in Radiotherapy for Lung Cancer?

While radiotherapy is a versatile treatment for lung cancer and can be used across various stages and types, not all patients will receive it. Eligibility depends on factors like the stage and location of the tumor, the patient’s overall health, and other available treatments. Radiotherapy is often a primary option for early-stage lung cancer when surgery isn’t feasible due to the tumor’s position, the patient’s health condition, or their preference.

It’s also used in conjunction with or following other treatments like surgery and chemotherapy. However, if the lung cancer is in an early stage and can be completely and safely removed through surgery in a healthy patient, surgery might be the preferred initial treatment. Prior radiation treatments to the same area could potentially limit the possibility of further radiotherapy due to concerns about cumulative radiation dose and tissue tolerance. The specific location of the tumor in relation to critical organs also plays a role in determining if radiotherapy is a safe and effective option, requiring careful planning and advanced techniques in some cases.

How Can Patients Support Their Health During Radiotherapy For Lung Cancer?

Supporting overall health during radiotherapy for lung cancer involves paying attention to diet, exercise, and mental well-being. For diet, it’s often helpful to eat slowly and try smaller, more frequent meals. Staying well-hydrated by drinking plenty of water is important. If you experience a sore throat or difficulty swallowing, opting for a soft diet and avoiding spicy or acidic foods might provide relief.

Gentle exercise, balanced with adequate rest, can help manage fatigue and boost energy levels. Staying as active as your condition allows is generally encouraged. For mental health, remember that it’s normal to feel uneasy about radiotherapy.

Communicating openly with your treatment team about any concerns or discomfort is crucial. Some centers may offer ways to help you relax during treatment, such as listening to music. Utilizing available support services can also be beneficial in coping with any side effects and maintaining a positive outlook throughout your treatment journey.

Written by Aren Karapetyan, MD