| A Patient's Guide to External Radiation
Therapy for Lung Cancer Author
Maria Werner-Wasik, MD
Bodine Center for Cancer Treatment
Thomas Jefferson University Hospital
Table of Contents
Introduction
Your doctor has recommended that you be evaluated for radiation therapy to treat your
lung cancer.
Normally, lung cells divide to produce more cells only when the body needs them. Lung
cancer occurs when cells divide and form more cells uncontrollably, creating a mass of
tissue called a tumor. Tumors can be benign and rarely a threat to life, or they can be
malignant.
Malignant tumors are cancers that can invade and damage nearby tissues and organs.
Cancer cells can also break away from a malignant tumor and enter the bloodstream,
spreading to other parts of the body where they can form new tumors.
Most lung cancer is caused by cigarette smoking. Tobacco smoke contains many
carcinogens harmful substances that damage cells. Over time, these cells can become
cancerous. The more a person smokes, the higher the risk of getting cancer not just
lung cancer, but also cancers of the mouth, throat, esophagus, larynx, bladder, kidney,
cervix and pancreas.
Although smoking is by far the major cause of lung cancer, it is not the only cause.
Exposure to other people's tobacco smoke (second hand smoke) increases the risk of lung
cancer among nonsmokers. Scientists have found that nonsmokers who live or work with
smokers have a higher lung cancer risk than nonsmokers who do not face this type of
exposure to environmental tobacco smoke.
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Radiation Therapy
Radiation therapy uses high-energy rays to damage cancer cells and stop them from
growing and dividing. In external radiation therapy, a beam of radiation is pointed at the
tumor by a machine outside the body. Treatments are given in brief daily sessions for
several weeks. The radiation therapy course for lung cancer or its complications usually
lasts two to seven weeks, depending on your particular circumstances.
The purpose of this booklet is to explain what you can expect during your radiation
therapy.
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Treatment Planning for External Radiation
Therapy for Lung Cancer
Before beginning your radiation therapy, we will design a treatment plan uniquely
tailored for you. This step usually requires two visits to the department before your
actual treatment begins.
Your first planning visit begins with a simulation, which takes about two hours.
Radiation therapists, working under the supervision of your radiation oncologist, perform
the simulation. At the beginning of this session, the radiation therapist will photograph
you for future reference and identification.
At times, you may have a positioning mold made to assist you in holding a specific
posture. If so, the radiation therapist will ask you to lie on a table to make a styrofoam
cast mold of your upper body. This mold will be used during treatment to be sure your body
position is the same each day. We may ask you to hold on to a bar positioned above your
head. This moves your arms out of the treatment field and allows us to use any angles of
the radiation beam necessary for your treatment. The therapist will mark your skin and
your mold with a marker, and place a few permanent freckle-size tattoo marks on your skin
for indelible reference points for the treatments.
If contrast is needed to visualize the planning fields, the nurse will start an
intravenous (IV) line to allow us to inject contrast. A separate consent for contrast will
be obtained along with an explanation of possible side effects.
A CT/simulation of your chest will be done in the department. Your radiation oncologist
will use the information with sophisticated computers to create a 3-dimensional image of
your chest as seen from all angles.
Your radiation oncologist will work with physicists and dosimetrists to plan the
direction and shape of the radiation beams used to treat you. This will help assure that
the entire intended treatment area is covered and the amount of radiation directed to the
surrounding normal tissues is minimized.
When you return for the second and final step in the treatment planning process, the
radiation therapists will take beam films (port films). You will be positioned as you were
during simulation under the radiation treatment machine, and X-ray images will be taken
from each of the beams that will be used in your treatment. Your radiation oncologist will
check that each of these is accurate in relation to the plan before your treatment begins.
This second step serves as a "dry run" or check of the treatment plan. It is
never used to evaluate the cancer.
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Receiving Your Treatment
Once your treatment planning and simulation is completed and your beam films have been
reviewed, you will begin your treatments. Treatments are given daily, Monday through
Friday, for two to seven weeks. You should allow about one hour for each treatment
session. We will try to accommodate your request for a daily treatment time, which can be
between 8 a.m. and 4:45 p.m.
After undressing and putting on a hospital gown, you will be asked to come into the
treatment room where the radiation therapist will precisely position you under the
treatment machine. The machine, which produces radiation (or high-energy X-rays), is
called a linear accelerator.
During the actual treatment you will be alone in the room, but the therapists can see
and hear you at all times through a monitoring system. You will not feel anything during
the treatment but you may hear the machine turn on and off. The radiation therapists may
come in and out of the room to set up each of the planned positions. The total time in the
room will be 10 to 20 minutes, but the actual treatment takes only a few minutes. Once you
are off the treatment table, you are not "radioactive."
Your radiation oncologist oversees your entire treatment. During the course of
treatment you will have weekly appointments with the attending radiation oncologist, a
resident physician and a nurse to evaluate your response to treatment and any side
effects. Please plan your time to allow for a longer visit on these appointment days. At
these appointments, feel free to discuss your concerns and ask any questions you may have.
If you would like to speak with the doctor or nurse at any time between these visits, ask
the radiation therapist to contact them.
Several times during your course of radiation therapy, the doctor will ask for repeat
verification films to be taken. These films are done for technical reasons and do not show
us, in a diagnostic way, whether your lung tumor is shrinking.
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Anticipating Side Effects of Treatment
You may have several side effects from radiation therapy. The most common side effect
of radiation therapy to the lung, especially if combined with chemotherapy, is
esophagitis, or painful swallowing. Your esophagus (swallowing tube) is in the middle of
the radiation field and can become irritated during radiation and chemotherapy. This
painful swallowing usually starts in the second or third weeks of radiation and may
continue for a short time after treatments are over. We will give you medication to
relieve the pain and make it easier for you to swallow. Although the medication will
provide some relief, the symptoms may not go away completely until one to two weeks after
the radiation course is complete.
The skin in the treated area may get red, like sunburn. This will eventually heal with
some skin flaking. If we are treating your chest only, you will not lose hair on your
head. However, if you receive chemotherapy along with radiation, this may happen.
In addition, you may feel tired, your cough may temporarily worsen because of the
irritation of the airways and your blood counts may drop.
If your tumor is large and we are treating a significant portion of your lung, you may
develop a condition called "radiation pneumonia." If that happens, you may
develop a cough, shortness of breath and sometimes fever, usually starting one to four
months after finishing radiation. This condition can be treated, and most patients improve
quickly. In a small number of patients, the lung tissue may scar months or years after
radiation treatments. Although this does not usually cause problems, it can sometimes
cause prolonged shortness of breath.
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Caring for Yourself
It is important that you do not use any lotions or creams on your skin in the area of
the radiation fields. If your skin becomes irritated, we will tell you what to do.
If you need any nutrition advice during the radiation course, particularly if you have
a poor appetite, our nutritionist and the nurses will be available to assist you.
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Following Up
After your treatment is completed, your doctor and nurse will want to see you in four
weeks and then every three to six months. The first follow-up X-rays (or CT scans, or MRI
scans) are usually obtained three to six weeks after radiation is finished. This period
allows enough time for the effect of radiation to show up.
We hope that this patient's guide helps in describing external radiation therapy for
treatment of lung cancer. If you have any questions, please feel free to discuss them with
any member of your healthcare team. You can reach them Monday through Friday at the
numbers listed below. If you need assistance after 5 p.m. or on the weekends, please call
our answering service at 215-955-6702 to be connected to the radiation oncologist on call.
Radiation Oncologist_____________________
Resident______________________________
Nurse________________________________
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Glossary
| Dosimetrist |
Someone who plans and calculates the proper radiation dose
for a particular treatment. |
| External Radiation |
Radiation therapy delivered by a machine that focuses on the cancer site. |
| Linear Accelerator |
A machine used to treat cancer. It creates and uses high-energy X-rays. |
| Radiation Oncologist |
A doctor with specialized training in the use of radiation to treat
tumors, especially cancer. |
| Radiation Physicist |
A scientist with extensive training in measuring and delivering radiation
doses. |
| Radiation Therapist |
A professional trained in the use of radiation treatment equipment and in
the accurate delivery of prescribed treatment. May also be referred to as radiation
therapy technologist. |
| Radiation Therapy |
A medical treatment that uses X-rays, gamma rays, radioactive isotopes
and other forms of radiation to treat disease. |
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