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.
Describes radical radiotherapy that aimed to cure his cancer.
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.
Describes what it was like in the simulator before the radiotherapy.
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 uncomfortable.
Recalls that the radiotherapy machine was very noisy and that his arms and shoulders were very uncomfortable.
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.
Describes her radiotherapy, which she found nerve-racking, and giving a hot sensation.
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.
He had CHART treatment three times a day, it was not painful in any way.
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.
Describes what it was like to have CHART treatment and says that her stay in hospital was pleasant.
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.
Recalls that radiotherapy had no side effects except that it made her a bit tired.
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.
Remembers the mask she had to wear while having radiotherapy to her head.
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 shows the mask.
Recalls her fear when the mask was made for radiotherapy to her head without explanation and shows the mask.
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.
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.
Describes radiotherapy she had for a 'hot spot' in her back that might have been caused by a cancer seed in the bone.
Describes radiotherapy she had for a 'hot spot' in her back that might have been caused by a cancer seed in the bone.
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.
Explains that radiotherapy eased some of the symptoms of mesothelioma.
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.
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