Radiotherapy to the Chest
Before you start your treatment, you must sign a consent form stating that you understand what the treatment involves, what the side effects are, and that you are willing to proceed
Radiotherapy must be ‘planned’ beforehand. This is also known as ‘measuring up’ and is important, as every person is different – we differ in shape and size, and (believe it or not) the position of our internal organs. This usually involves having a CT scan, sometimes with oral contrast or an injection of contrast. Your position on the treatment couch will be lined up using lasers, and the radiographers will be taking measurements. Small tattoos will also be placed to mark position.
All the clever stuff then goes on behind the scenes when you are back at home. Firstly the doctor decides what he wants to treat with radiation, and also identifies the critical areas to avoid – such as spinal cord, normal lung, and oesophagus - This is all marked on the scan. The physics department then do a lot of work to decide how best to treat the area the doctor has identified, and also how to best avoid the critical areas. This can take a long time and be very complicated, and discussions often have to take place with the doctor. The physics department will then decide how many beams of radiation to use, from which angles, and where to shield out critical areas. The doctor will examine the final radiation treatment plan, sign it off, and prescribe the dose and number of fractions of treatment.
The plan is then double and triple checked to make sure there are no mistakes, before the data is fed into the radiotherapy treatment machine (Linac) computer. There it stays until you have completed your treatment.
Radiotherapy treatment does not hurt. We direct beams of high energy x-rays into the cancer, taking great care to avoid normal tissues. Unfortunately normal tissues cannot be avoided completely, and this is why radiotherapy has some side effects. You will not feel anything during treatment. It is like having a scan. Treatment takes roughly 15 – 20 minutes, and most of this time involves the radiographers making sure you are in the right position so we are sure to treat the correct area each day. Radiotherapy is often given over several weeks in order to give normal tissues time to recover each day.
Aim of treatment
The benefit of having radiotherapy for lung cancer is the possibility of shrinking the cancer to reduce symptoms (palliative radiotherapy) or attempting to cure the cancer (radical radiotherapy). The aim of treatment may be different for each person and the doctor will discuss this with you. The doctor will also discuss with you any other treatment options and what might happen if you had no treatment.
Immediate side effects
Acute side effects are temporary and affect many people having radiotherapy. They will vary depending on which area is being treated, and your general level of fitness. They usually develop 10 to 21 days after the first day of your treatment and can last for about two weeks after treatment is complete. They are often caused by swelling and inflammation induced by the radiation.
Here are some of the more common side effects:
- Tiredness following treatment. Extremely common. This can last for a number of weeks after treatment has ended. Make sure you take it easy and rest when you feel tired.
- Skin in the treated area becomes a little pink or red, like sunburn. It may also feel dry or itchy. You may bathe or shower during treatment, but do not have the water too hot. Use mild baby soap, but try not to rub the treated area, particularly if it is red or itchy. It’s best to pat the area dry with a soft towel. Avoid perfumed talcum powder or lotion. If your skin is very sore, ask your doctor for advice. You will be given a moisturising cream to apply to the treated area and the situation will be constantly reviewed during your treatment.
- Soreness when swallowing due to the gullet (oesophagus) becoming irritated by the radiotherapy treatment. Your doctor can prescribe soothing liquid medicines to help you. Cool drinks or ice-cream can also help. Avoid very hot spicy food
- Increase dry cough and sputum (spit) which may contain a little blood. This is quite normal. If you are having difficulties with this during treatment, let your doctor know. Coughs can sometimes worsen when treatment finishes.
- Shortness of breath, especially on exertion. This can accompany the cough and usually settles within weeks. Steroids are sometimes given if severe.
- Hair loss can occur within the radiation field after 2 – 3 weeks and is usually temporary.
Possible late side effects of treatment
- Radiotherapy may leave the lung with some scarring (fibrosis). This can mean that your lung doesn’t work quite as well as it did before, and you may notice a slight increase in breathlessness. If the rest of your lung works well, any symptoms should be mild. If breathlessness becomes a problem, consult your doctor. Inflammation of the lung (pneumonitis) can also occur weeks & months after treatment which often needs steroid treatment. Again, consult your doctor.
- Radiotherapy may occasionally cause scarring in the gullet (oesophagus), making it difficult to swallow solid food. A minor operation to stretch the gullet may be needed.
- Radiotherapy may in extremely rare cases lead to injury to the spinal cord which can cause permanent difficulties in walking and loss of sensation in the lower body. Every effort is made to carefully plan your treatment so as to avoid this problem.
- Radiation can also cause cancer as well as treat it. This is rare and unusual and often takes 20 years, and your doctor will carry out the treatment because its benefits greatly outweigh any risks.
During treatment
A doctor will see you in the radiotherapy department or clinic during treatment. This will be an opportunity to discuss any problems.