Lung Cancer

Lung cancer - radiotherapy

Radiotherapy is often used to treat people with lung cancer. It can also be used to shrink tumours before surgery. There two main types of radiotherapy;

external radiotherapy (the most common form) and
internal radiotherapy (also known as brachytherapy)

External radiotherapy is aimed at your body from a machine and is similar to having an X-ray you may have between 20 -36 treatments depending on your treatment plan.

With Internal radiotherapy a narrow tube containing a radiation source is put inside your airway for a few minutes using a bronschoscopy. Internal radiotherapy may be given when the tumour is blocking one of the airways and has made the lung collapse. It's a simple way of opening up the airway. If you have this type of radiotherapy, you usually need only one session of treatment. None of the people we interviewed had internal radiotherapy so all references to radiotherapy refer to external radiotherapy. For non-small cell lung cancer it may be used as the main treatment, particularly if the cancer cannot be removed with an operation.

Describes radical radiotherapy that aimed to cure his cancer.

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Age at interview: 75

Sex: Male

Age at diagnosis: 69

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A few months later I found that I was coughing up blood again. I went back to the consultant whereby I went through virtually the same process of standard chest x-rays, CT scans and it was diagnosed that the lung cancer had spread to the upper lobe as well. Unfortunately this was not operable and I was then sent to the cancer centre whereby I saw a consultant oncologist and further CT scans and it was decided that he would carry out a process of radical radiotherapy. Now this consisted of radiotherapy every day for one month, except Saturdays and Sundays and some days I had radiotherapy applied at 9 o clock in the morning and went back again at 4 o clock in the afternoon for a further dose. Following the month of radiotherapy I have since visited the oncologist every three months for the past four years and I have x-rays and tests done and at the moment the cancer is at bay. At present he has just promoted my visits to once in six months and I do not return again until later this year.

Before radiotherapy starts a simulator (a special X-ray machine), is used to plan the treatment. One woman said that it felt like being in a space ship. People recalled that they were measured and marked with little tattoos in preparation for the treatment.

Describes what it was like in the simulator before the radiotherapy.

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Age at interview: 73

Sex: Female

Age at diagnosis: 70

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He said [the doctor], "When you leave my office there'll be a young lady waiting to meet you and she'll explain anything you want to know," and that's when I met my cancer nurse and she's an angel. She made me a cup of tea and she told me that I'd got non-small cell cancer which I think is the best sort to have. She explained that I would have a course of radiotherapy, which hopefully would shrink the cancer and that I had to go to our local hospital, not the same one, the one on the outskirts of town. And you attend something called a simulator and the only thing I can say about that is when I lay on the simulator machine it was like being in a space ship. There were little lights in the ceiling, you were in a room, you were lying flat on the bed and there were, voices from people outside the room and they were saying things like 93, 74. And that's all I could think it was like, lying in a spaceship with all these strange things going on. It was in fact, a simulator is a machine that measures you, measures your tumour, gives them an idea where to direct the radiotherapy, and a short time after that the doctor came in and he said "You'll be starting in a few weeks and we're going to give you twenty doses following on; five times a week."

Radiotherapy is painless, though the treatment table may be a bit hard and uncomfortable, and the machines used for radiotherapy can sometimes be a bit noisy. One man, who had non-small cell lung cancer, said that during radiotherapy he felt some discomfort due to the position of his arms, which he had to keep above his head. One woman said that during radiotherapy she felt a hot sensation.

Recalls that the radiotherapy machine was very noisy and that his arms and shoulders were very...

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Age at interview: 57

Sex: Male

Age at diagnosis: 56

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Then this machine comes across and it's about I'd say about three foot across, it doesn't look like anything in particular, it just looks like, you look inside it and it looks like, it looks like a camera shutter. Have you ever looked at a camera shutter, inside the actual bit behind the lens, you know how it's all corrugated well it's exactly the same as that. Because that's what it is, it's basically a camera and it's all got these things. But the thing is the inside actually moves so it can change the angle and change the aperture as well so it's basically a massive great camera.

So you're lying there and you hear those clunks and bloomin' bangs and crunches and you're thinking what the heck is all this noise? But it's nothing to worry about, it's the way, when you think about it you need a lot of electricity to get the machines working, or to work these machines because it's using x-rays so they need a lot of power. So the reason it's making all the clunking and grinding and not to worry about it is because the, if anybody knows anything about electricity the maker breaker, when it makes it clunks and when it breaks it clunks, but the thing is it's the two in between the actual noise of doing that which is the most disturbing. But once it's described to you why it's happening because being a nosy person I actually asked, I asked you know because what happens is you're put under there you get a clunk then an, excuse my noises a "weeee" then it'll stop, then this noise, this clunking noise will happen again and it'll start up and all your hear then is "beep beep beep beep." Now you automatically do it, everybody does it and if you don't do it there's something wrong with you, you actually count the beeps.

So it comes up to the side and it starts again and you count these, you just count them because you know when your treatment is finished because once your treatment is finished you can get your arms down. Because one thing, you get an involuntary twitch in the muscles of the shoulder you can't do anything about but once you've got your arms down it's okay but your arm is stuck up there for what ten minutes and it can be very, very uncomfortable. Well especially if you've got a stiff shoulder or something like that anyway. But I was okay but it was still nice to get my arms down.

Describes her radiotherapy, which she found nerve-racking, and giving a hot sensation.

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Describes her radiotherapy, which she found nerve-racking, and giving a hot sensation.

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Age at interview: 55

Sex: Female

Age at diagnosis: 55

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I waited for about, just over an hour, which was fine, we could have cups of tea and things, you know. Then I was called back in, laid on the table, it's in an operating theatre but, just like an X-ray room really, and they'd marked my chest already. And you just didn't move, you know, when the girl said, 'Right, I'm going to ask you to keep still', you just laid as still as possible, which was okay. It started, the machine came down a little way and I sort of, a cross light came onto your body. It's, it was nerve-racking, it was really nerve-racking. I was pretty wound up and quite scared but now, come on, keep still, keep still, and a buzzer would go and then you knew that you could move, and you were just hoping and hoping for this buzzer to go and, and finally it does, and you think, Gosh (sighs). It felt like, something warm going through my chest, which seemed to get quite hot but not uncomfortable. When I had it from underneath, through and then from the top through to the back. When this was taking place, I could feel my back getting very, very hot. I'd just had an operation a few years ago on my back and it seemed to be just that spot, and it was getting very hot, very itchy and quite uncomfortable. But I just laid still and, and hoped and prayed for this buzzer to go off, which it did.

In some cancer centres patients with non-small cell lung cancer are offered an accelerated regime called CHART (continuous hyperfractionated accelerated radiotherapy). Radiotherapy is given three times a day, over a shorter period of time. One woman recalled the time she spent in hospital while she was having CHART. She said that radiotherapy was not frightening in the least.

He had CHART treatment three times a day, it was not painful in any way.

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Age at interview: 72

Sex: Male

Age at diagnosis: 72

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I had CHART treatment, which, I said to him, 'Is it painful?' He said, 'No'. So, anyway, I had this treatment three times a day. It's very intensive, every six hours. You start eight in the morning, then two in the afternoon, then eight in the evening. So your feet don't touch the ground. It only takes about ten minutes. The first time it's about half an hour because they have to chart you and mark you up, and everything like that. And, but there's no pain to it at all.

Is this in the Radiotherapy department?

Yes, yes, Radiology, yes.

Describes what it was like to have CHART treatment and says that her stay in hospital was pleasant.

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Age at interview: 81

Sex: Female

Age at diagnosis: 81

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How many people were in the ward?

Well we were in the hostel wing and there were, we each had our own sort of bedroom with a curtain that was pulled around and had our own television and everything and there were four in each, there were twelve people altogether, there were four in this particular part of it. Not that it's exactly like a ward because, and then we had a shower and everything there. And unless you needed to see the nurse you didn't see a nurse.

It sounds rather nice.

It was rather nice actually. It's for people who can look after themselves you know.

So three times a day you walked down to radiotherapy did you?

No, no we had (laughs) it's a long way to go, we got taken in a wheelchair by the porters who were quite fun. It was miles, absolutely miles, you couldn't possibly walk.

Right.

And we were rather lucky because where they sold the newspapers was just across the grass so we even got newspapers in a morning.

And then when you got to the radiotherapy department you were there for how long?

Well you had to wait for whoever it was who was in front of you to come out and you were in there quite a long, I seemed to be a long time, it might've been about a quarter of an hour or something like that.

Actually in there having the therapy?

Yes, because they have to get you sort of arranged on the stretcher and sorted out and you know.

Did you have a session beforehand where they had to mark exactly where to do the radiotherapy?

Oh yes.

Can you say a little bit about that?

Well I don't know whether it's a ball point pen or whatever it is but they do, you do go down there and they mark exactly where they've got to put the zapper, I call it zap you know put the machine. And you have several, several times you have it done, it isn't just once they stop and then they do it again and then they do it again so it's, but the nurse is talking to you the whole time, you know talking and telling you, you know asking what she did that night or last night or something so it's not frightening. I didn't find it frightening; I didn't find anybody, either of us, the three of us, we, none of us found it scary.

In small cell lung cancer, radiotherapy may be given with or after chemotherapy to improve results or to reduce symptoms. Most people said that despite expectations the radiotherapy was painless and nothing to worry about. However, one person said that the tattoos were quite painful, and that during treatment she felt rather exposed and freezing cold (see also 'Side effects of radiotherapy for lung cancer').

Recalls that radiotherapy had no side effects except that it made her a bit tired.

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Age at interview: 64

Sex: Female

Age at diagnosis: 57

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They took the stem cells out of my blood halfway through. I had also had, halfway through, after about three lots of chemo I went and had radiotherapy every day for three weeks I think yeah.

Can you explain about that?

Yeah well that, I was a bit scared about going for that because the hospital that I went to for that was where my Dad had been (laughs) all those years earlier. So I was a little bit nervous about going but once again it's nothing, it's just, well in my case it wasn't. I'd heard different people say things that you know that if they gave you too much it burnt you and things like that, so I was a little bit wary of it. But in my case it was nothing I just laid on, you go on what they call a simulator first and they measure you all up and there's just like beams coming on to you and they finish up they put a little tattoo into you just so that they've got a reference point if they lose all the workings out I suppose. And then I just went every day and you're just on it for two minutes, you just lay on this table type thing and they measure you up and this big beam thing comes over you and you don't feel anything so

So which part of your body exactly did they have to treat?

That was to my chest, yeah all left hand side of my chest yeah. So as I say I was very lucky with that because I never felt anything with it. You know I used to think, apart from a little bit towards the end of the three weeks, I think I was beginning to feel a little bit tired with it and I think that's one of the sort of side effects of, I suppose it possibly depends on how severe the radiotherapy is, whether they give it at different degrees or what, I just don't know, I don't really know that much about it but it certainly didn't really have any side effects for me other than a little bit of tiredness.

People with small cell lung cancer may also be given radiotherapy to the head to prevent the disease spreading there. It is important that people do not move during treatment. Therefore before treatment starts a plastic mask (or shell) is usually made to fit each person's head. The masks are made using dental alginate, gauze, plaster of Paris and Perspex. They are worn during treatment and fixed in position to prevent movement.

Remembers the mask she had to wear while having radiotherapy to her head.

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Age at interview: 55

Sex: Female

Age at diagnosis: 50

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And they suggested that I have 15 sessions of radiotherapy on my chest and 10 on my head. So that day while I were there, once I'd agreed to have the brain done as well they did like a mask, I looked a bit like Hannibal Lector, you know when he had the mask on his face. It were the same sort of material like white with little holes all over, like an ice hockey players goalie's hat. And they used to strap you to the table you know have straps on and bolts and they'd bolt you down like that you know. And it only lasted for about probably 30 seconds at either side and they used to do that after they'd done the chest part, that were probably two minutes at either side, back and front. And it were just an awful feeling, having this thing pressing down on your face, it's for your own benefit so you don't move while it's being done; but it were fine with the radiotherapy, I didn't have a problem with it whatsoever. I used to get there for 9 o clock, have it, and we were never kept waiting very long, a few minutes that were all, and then I'd go to the hospital restaurant, have a sausage sandwich or a bacon sandwich and get into work for about 10 o clock and I were fine.

When the masks are made the staff should explain each stage of the procedure, which is painless. However, one person had a bad experience because she wasn't informed of what was happening.

Recalls her fear when the mask was made for radiotherapy to her head without explanation and...

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Age at interview: 53

Sex: Female

Age at diagnosis: 52

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Me and my husband had an appointment to go to be measured up, it wasn't, I wasn't explained to what they were gonna do to me. Anyway they took us into this room. They put like a swimming cap just on my, the back of my head. Told me to lie down and he said 'You'll, this will feel warm on your face.' And, he put it on my face and then it was like I was being buried alive, I mean I don't know what they, I mean all I know that they were doing was what my husband told me. They put like this green gunge on my face and then plaster of Paris, like strips of plaster of Paris over my face, that was to make the mould. But I couldn't see, I'd just got that part to breathe through. But my, my husband said he could see my heart going like that, that's how frightened I was and because, I mean you've probably had, plaster of Paris and they press it and I felt as though I was being buried alive, it was really horrible.

Did they explain?

No they didn't tell me beforehand. Anyway they sort of once it, he said 'This will take about two minutes to set,' it seemed like two hours! Anyway they eventually pulled it off and I just sat up and I just burst out crying, it was the most horrific thing I've ever been through. I think that was the worst of all I went through, it really was horrific. And I says 'Why didn't you tell me what you were gonna do?' And they said 'We find it's better if we don't tell people,' and I couldn't understand that because if, I mean I could have had a bad heart or anything like that you know. And I mean my husband, he said my chest was going up and down like that. You see with children they tend to put children out while they do the mask. But anyway I did complain to, to a nurse in the hospital but I never got anywhere.

I'm so sorry. What an awful experience.

It was. But, and this was the result of it. When they, when they gave it to me there wasn't any holes there and I made them cut the holes out because I, I said I need to see what you're doing to me. But what happened was - it's fitted tight on your face there [shows mask] and you, it was actually clamped down and because the rays had to keep the, exit at the right spot, but that was clamped down tight on my face and I couldn't move and it was really frightening. And I had to have that done eight times.

Head masks may also be made out of a thermoplastic material. A flat sheet of this material (which has plenty of holes in it for breathing), is heated in a water bath or hot air oven until it goes floppy. It is then placed over the patient's head to make a mask. As it cools it goes rigid. One man described his experience and demonstrated how his mask fitted his face.

Demonstrates how his mask was made for radiotherapy to his head, a painless procedure.

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Demonstrates how his mask was made for radiotherapy to his head, a painless procedure.

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Age at interview: 57

Sex: Male

Age at diagnosis: 57

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Right the very next day they took me into a room to make a mask for my head. The reason for the making of the mask is quite simple, instead of putting tattoos all over your head and down here and down here they make a mask and then they make the markings they need onto the mask so that there's no tattoos on your head. So that's quite good for people that don't like tattoos, as you probably see it doesn't worry me (laughs). Nevertheless this is the material that they used to make my mask. It's, I don't know actually what it is but it's just a plasticky, rubbery stuff, quite solid. And they literally put that into hot water which makes it very, very soft and very pliable and then they allow it just to cool off a little so that it's warm and the heat doesn't affect you and then they put it over your head like so and mould it to your face. But you know like they do on all good programmes here's one we made earlier (laughs), [shows masks]. So I'll just slip this on so that you can get a good look and see what it's like and I'll pull it as tight as it is when they treat me. So that would be it and I can't talk.

How did it feel when you were having it made?

No problem whatsoever. A friend of mine had one made, there are two different types, the other one is very, can be quite horrid, not hurtful or painful or nasty but if you're claustrophobic at all it can be quite terrible. As you can see with this one they leave lots of room, you can breathe through your nose, you can breathe through your mouth if you want to, it's advisable to keep your eyes closed because they're pushing the thing in all round and they're moulding it around all the item so it's advisable to keep your eyes closed which I did.

It took about; the whole thing took about eight or ten minutes and there was no pain involved, there was no aggravation involved. As I say the worst thing is a fear if you're agoraphobic and I'm not, sorry claustrophobic not agoraphobic, claustrophobic and I'm not I can imagine that you would be fairly nervous of what's going to happen to you but as I said when you get out a nose hole left like that, providing you can just close your eyes and breathe through your nose you feel nothing at all, all you feel is somebody gently touching and they're just moulding this into that and it is literally that simple, it doesn't hurt a bit.

And then I don't know if you can see here but there's one, two, three holes that they've made a little bit bigger than the rest and what happens with the treatment is that's put on and then my head is inside it of course and that is bolted down to the table because when they're treating the head which is actually the brain, not the head it's the brain, they don't want the x-rays to slip and touch an eye and do damage so that's purely there for the protection of my eyesight and various other bits and bobs that I wouldn't even understand that are attached to the brain. But it's the brain only that gets the treatment and that treatment as I say is to stop the cancer, which is a small cell cancer, and can go anywhere in your body, but it stops it going to the brain because that can be particularly nasty.

Radiotherapy can also help in treating lung cancer that has spread to the brain, or if there is a possibility that it has spread to the bones (metastases), and is causing pain.

She describes having radiotherapy to her head after the cancer spread to her brain.

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She describes having radiotherapy to her head after the cancer spread to her brain.

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Age at interview: 55

Sex: Female

Age at diagnosis: 55

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So I went into hospital and everybody who saw me then says that I was quite odd, well I wasn't like myself. So as part of being in there I had a scan of my brain and they discovered that the cancer had actually gone to the brain so I think that explains the odd behaviour and whether or not that's what precipitated the sickness I don't know I just thought, I thought when I was being sick that I'd just got some sick bug. But as a result as I say of being hospitalized for this sickness they said that the cancer had moved to the brain, which is clearly not what I would have liked to hear (laughs) and was actually I found, well I found quite difficult to cope with.

I had radiotherapy to both sides of the brain at the front and they positioned things very carefully for obvious reasons, they don't want to radiotherapy the wrong bit and a machine is drawn up near your head and it sort of makes a noise. They can hear you so that if you panic in any way, which I didn't feel any need to panic at all, you, they'll stop and they'll come and get you and things. And it's fairly short but I think that would depend on what you've got because they gave me a short burst on one side and a longer burst on the other. Yes I think that's about it.

Was it just on the one occasion you had it?

Two occasions, yes, a week apart.

Describes radiotherapy she had for a 'hot spot' in her back that might have been caused by a...

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Age at interview: 73

Sex: Female

Age at diagnosis: 70

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I was fine until this summer, which is what just above two years, and I started to feel there was something wrong, I wasn't sure what it was. It was like a little niggle it you know what I mean, like a toothache perhaps and I said I'm sure there's something wrong, although I was feeling fine, I was doing my own housework and everything. And the doctor said, "Well sometimes radiotherapy batters your bones, your ribs and things,' so he said, "We'll have a bone scan and see if that's what it is." He thought it was the radiotherapy on the bones but when I had the bone scan they pinpointed what they called a hot spot on my back and they gave in the measurements and it was exactly where I could feel something. And this was getting worse so by the time he got the results it was a pain and he said, "Well I think because they're not sure," it was what they call non-conclusive, they said it could be a fracture, an old fracture or it could be a cancer seed that had sneaked into the bone. So I had another scan, a CT scan which scans the soft parts inside your body and this pinpointed the very same spot. So still not sure but he said, "We will give you one blast of radiotherapy."

The latest treatment was so quick I lay down and she said "Oh I'll be back in a minute." I didn't, well I was so certain they were just measuring up I even took my glasses off while it was, but she said it was alright because I hadn't moved my back. She just came in and said "Right you're done," and I hadn't, I looked round like that and there was, I could just see a light with figures on my back but it was finished and it was so quick, so easy, so nice. I went in at 4.30 and I must've been out for 10 to 5, there was no waiting about whereas previously you could wait twenty minutes or so before you went in you know.

In the case of mesothelioma radiotherapy may be given to alleviate symptoms.

Explains that radiotherapy eased some of the symptoms of mesothelioma.

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Age at interview: 55

Sex: Male

Age at diagnosis: 54

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Yes what the radiotherapy does actually is it helps with the symptoms. It holds back the tumour for a short while and it helps with the pain. It doesn't really reduce the tumour because the tumour; there's nothing you can do to stop the tumour growing.

This is in the case of mesothelioma?

Yes it's, all it does really is makes it a lot more comfortable. I went through a period of, in I think it was in June this year when I started to get, my chest started to get very, very tight and thick with phlegm and stuff. I was put back on radiotherapy then and that stopped the phlegm coming up on my chest which does in actual fact help you breathe a bit easier. So for them reasons radiotherapy is a good tool. But I was offered, I could've had chemotherapy at the start, a year ago I could've, they suggested that chemotherapy may help with the symptoms but what chemotherapy does is it gives you other symptoms, hair loss, being sick and feeling generally ill and at the time I was not feeling ill. So the two consultants I had seen suggested that I leave the chemotherapy, just stick with the radiotherapy.

There is some research looking at treatment of very early stage lung cancers with a form of radiotherapy using a machine called Cyber knife. This machine delivers a high dose of radiation, but it uses multiple radiation beams instead of just one. This means doctors can aim very precisely at a tumour and give a lower dose to surrounding normal tissues.

We have not yet been able to interview anyone who has had radiotherapy using a internal radiotherapy or Cyber knife machine. If you have experience of this treatment and you would like us to include your story on this website, please email hexi@phc.ox.ac.uk.

Last reviewed May 2016.
Last updated May 2016.