Radiotherapy treats cancer by using high-energy x-rays to destroy the cancer cells, while doing as little harm as possible to normal cells. The treatment is given in the hospital radiotherapy department. The number of treatments you have, and the length of time they take, will depend on the type of cancer as well as its size and position.

Radiotherapy is usually given by aiming high-energy x-rays at the lung from a radiotherapy machine. This is known as external beam radiotherapy.

Radical radiotherapy Radiotherapy can be given with the aim of curing the cancer (radical radiotherapy). This may be instead of surgery. There are different ways of having radical radiotherapy.

You may have treatment every week day with a rest at the weekend. The treatment will be given for 3–7 weeks.

Or you may have radical radiotherapy using CHART (Continuous Hyperfractionated Accelerated Radiotherapy). Here, the dose of radiotherapy is divided so that more than one treatment, or fraction, is given each day. People having CHART are given treatment every day, including weekends, until the course is over. The course usually lasts 12 days.

Palliative radiotherapy Radiotherapy may also be used to control symptoms (palliative radiotherapy). Often only one or two treatments are given. Sometimes a higher dose of radiotherapy is given over two weeks if the doctor thinks this may be helpful. Treatment is given each weekday with a rest at the weekend.

Sometimes a type of internal radiotherapy called endobronchial radiotherapy or brachytherapy may be used. This type of radiotherapy may be given when the tumour is blocking one of the airways and has made the lung collapse. It is a simple way of opening up the airway. If you have this type of radiotherapy, you usually need only one session of treatment.

To make sure that the radiotherapy works as well as possible, it has to be carefully planned. On your first few visits to the radiotherapy department you will be asked to lie under a large machine called a simulator, which takes x-rays of the area to be treated. Sometimes, a CT scanner can be used for the same purpose. Treatment planning is a very important part of radiotherapy, and it may take a couple of visits. The doctor who plans and supervises your treatment is known as a clinical oncologist.

Marks may be drawn on your skin to help the radiographer, who gives you your treatment, to position you accurately, and to show where the rays are to be directed. These marks must remain visible throughout your treatment, but they can be washed off once it is over. Occasionally, tiny permanent marks are made on the skin in case further treatment is needed later. At the beginning of your radiotherapy you will be given instructions on how to look after your skin in the area to be treated.

Before each session of radiotherapy the radiographer will position you carefully on the couch, either sitting or lying, and make sure that you are comfortable. During your treatment, which only takes a few minutes, you will be left alone in the room, but you will be able to talk to the radiographer, who will be watching you. Radiotherapy is not painful, but you do have to stay still for a few minutes while the treatment is being given.

Radiotherapy to the brain

Some people with small cell lung cancer are given radiotherapy to the brain. This is because there is a risk that the cancer cells will spread to the brain. Giving radiotherapy in this way is known as prophylactic cranial radiotherapy (PCR). To make sure that the correct area of the head is treated, a soft clamp is used to hold the head still. Sometimes a see-through plastic mask is made to hold the head during treatment. PCR is usually given as daily treatments, Monday to Friday.

If you are having endobronchial radiotherapy, a thin tube will be temporarily put inside your lung using a bronchoscope. The source of radiation will then be put inside this tube, and taken out once treatment is over.

Radiotherapy can cause general side effects, such as feeling sick (nausea) and tiredness. It can also cause flu-like symptoms for a few days, or chest pain. These side effects can be mild or more troublesome, depending on the strength of the radiotherapy dose and the length of your treatment. Your radiotherapist will be able to advise you about what to expect.

Problems with swallowing

After two to three weeks of treatment, the main problem you are likely to notice is difficulty in swallowing. This may be very uncomfortable. You may also have heartburn and indigestion. This happens because the radiotherapy can narrow your gullet (oesophagus). Tell your doctors if you have problems swallowing, as they can give you medicines to help. If you don’t feel like eating, or have problems with swallowing, you can replace meals with nutritious, high-calorie drinks. These are available from most chemists and can be prescribed by your GP. Our section on diet has some helpful hints on how to eat well when you are feeling ill.

Tiredness

As radiotherapy can make you feel tired, try to get as much rest as you can, especially if you have to travel a long way for treatment each day.

Skin care

Some people develop a skin reaction similar to sunburn. Pale skin may become red and sore or itchy; darker skin may develop a blue or black tinge. You will be given advice on how to look after your skin by the radiographer giving your treatment.

Hair loss

With external radiotherapy, your hair will fall out within the treatment area, such as chest hair for men, or head hair if you are given prophylactic cranial radiotherapy. The hair usually grows back, although occasionally the hair loss is permanent.

Feeling sick

Nausea can usually be treated by anti-sickness drugs (anti-emetics), which your doctor can prescribe.

All the side effects should disappear gradually once your course of treatment is over, but it is important to tell your doctor if they continue.

Radiotherapy treatments for lung cancer do not make you radioactive. It is perfectly safe for you to be with other people, including children, throughout treatment.