Key takeaways

  • Radiation therapy is a common treatment for non-small cell lung cancer (NSCLC) that uses concentrated radiation to damage cancer cells’ DNA and slow or stop cancer tumor growth.
  • Different types of radiation therapy can be used based on the cancer’s stage and location, each with varying delivery methods to target tumors while minimizing damage to healthy tissues.
  • While radiation therapy does come with side effects, they can often be managed with lifestyle strategies, and this form of treatment can often ease NSCLC symptoms and improve outcomes.

Lung cancer is the leading cause of cancer-related deaths in the United States. Although there are several types, non-small cell lung cancers (NSCLCs) account for about 85% of all cases.

While this diagnosis can feel overwhelming, treatment options have expanded significantly over the years, and research into new therapies continues.

Radiation therapy for NSCLC can play different roles in treatment depending on how advanced the cancer is. In later stages, it may help relieve symptoms and, in some cases, prolong a person’s life.

Treatment can sometimes be intensive, so it’s important to talk with a doctor about the potential risks and benefits of radiation therapy, including possible side effects and how it may affect quality of life.

This article discusses how radiation therapy is used to treat NSCLC, the different types available, how effective it can be, and ways to manage common side effects.

Cancer develops when cells in the body grow and divide in an uncontrolled way. This can lead to the formation of tumors, which are large lumps of abnormal tissue. When tumors form in an organ, they can interfere with how it works and, in some cases, become life-threatening.

In lung cancer, these abnormal cells divide and grow in the lungs. In more advanced stages, cancer cells can spread (metastasize) to other parts of the body, such as the brain, liver, or kidneys.

Radiation therapy uses high doses of radiation to damage the DNA of cancer cells. This prefents them from growing and dividing, which can slow the progression of the disease or shrink tumors over time.

Internal vs. external radiation therapy

There are two main kinds of radiation therapy used to treat NSCLC: external and internal.

External radiation therapy uses a machine outside the body to deliver targeted radiation to the tumor. It works similarly to an X-ray, but at much higher doses designed to destroy cancer cells while minimizing damage to surrounding healthy tissue.

Internal radiation therapy involves placing a source of radiation directly inside the body, close to or within the tumor. This allows doctors to deliver a high dose of radiation directly to the cancer while limiting exposure to nearby healthy tissue.

The American Cancer Society notes that only some types of radiation therapy are appropriate for NSCLC. Doctors may use these radiation therapies alone or alongside other cancer treatments.

Stereotactic body radiation therapy

Stereotactic body radiation therapy (SBRT), also known as stereotactic ablative radiotherapy, is a specialized form of external radiation therapy. Doctors use SBRT when a person’s health prevents them from undergoing surgery.

Traditional radiation therapy is often delivered over several weeks in small doses. In contrast, SBRT provides fewer but stronger doses of radiation, allowing for a shorter treatment course.

Because these high doses of radiation can also affect nearby healthy tissues, SBRT requires a high level of precisions. During treatment, a person may be positioned in a custom body frame or in a device that limits their movements. This helps ensure that the radiation is accurately targeted at the tumor while minimizing accidental exposure to surrounding healthy tissue.

3D conformal radiation therapy

3D conformal radiation therapy (3D-CRT) is an advanced form of external radiation therapy.

With 3D-CRT, doctors can use imaging and computer technology to create a precise map of a tumor. This allows them to carefully plan treatment and control the shapes of radiation beams to match the tumor’s size and location.

This precise delivery makes it less likely that 3D-CRT will damage surrounding healthy tissue.

Intensity-modulated radiation therapy

Intensity-modulated radiation therapy (IMRT) is a different form of external 3D radiation therapy.

As with 3D-CRT, IMRT using imaging and computer planning to control, shape, and direct of the radiation beams. at a tumor However, IMRT also allows doctors to adjust the strength or intensity of each beam. This added level of control makes IMRT very useful for treating tumors near important body parts, such as the spine.

There is also a version of IMRT called volumetricmodulated arc therapy (VMAT), which delivers radiation as the machine rotates around the body. This approach can shorten treatment times while maintaining precise targeting.

4D conformal radiation therapy

4D conformal radiation therapy (4D-CRT) is an advanced form of external radiation therapy that accounts for tumor movement, like movement caused by breathing.

In lung cancer, tumors can shift slightly as a person inhales and exhales. With 4D-CRT, doctors use imaging over time (the “fourth dimension”) to track these movements and create a more accurate treatment plan.

Doing so helps ensure radiation is delivered more precisely to the cancer while reducing exposure to surrounding healthy tissue.

Stereotactic radiosurgery

Despite its name, stereotactic radiosurgery (SRS) is not a form of surgery, but another type of external radiation therapy. Doctors typically use SRS to treat single brain tumors, including those that have spread from NSCLC.

One approach delivers 200 beams of radiation at the tumor, all from different angles. Another method uses a single beam of radiation that continuously moves around the head, targeting the tumor from multiple directions.

SRS can deliver a large dose of radiation in a single session or a small number of treatments. Sessions may last several minutes to several hours.

Brachytherapy

Brachytherapy is a type of internal radiation therapy. Doctors may use it to shrink tumors in the airways. This can help relieve the symptoms of NSCLC, such as breathing difficulties or coughing.

During brachytherapy, a doctor places a small source of radioactive material near a inside the tumor. This is typically done using a flexible tube called a bronchoscope. This allows the doctor to view the airway with tiny camera and deliver the radiation exactly where it’s needed.

The radioactive source may be left in place for a short period and then removed. In some cases, a lower-dose source may be left in the body indefinitely.

Proton therapy

Proton therapy is a type of external radiation therapy that uses protons, or positively charged particles, instead of x-ways to treat cancer. The main advantage of proton therapy is its ability to deliver radiation very precisely to a tumor with minimal exposure to surrounding healthy tissue.

This precision is especially useful to target tumors located near critical organs or structures, such as the heart or esophagus. It works by damaging the DNA of cancer cells to slow or stop their grown and shrink tumors over time.

Because proton therapy can limit damage to healthy tissue, it may reduce certain side effects compared to conventional radiation, though it is not suitable for everyone.

Many doctors recommend some form of radiation therapy to treat NSCLC. However, the success rate of radiation therapies can vary depending on the stage of the cancer.

Radiation therapy has generally not been found to be particularly useful for early-stage NSCLC. Doctors have typically only recommended it when a person with early stage NSCLC cannot undergo surgery, or if they have other serious health conditions alongside NSCLC that make surgery risky.

However, a 2019 study of 288,670 people across all stages of NSCLC found that those who had received radiation therapy had a higher survival rates than those who had not.

The benefits and risks of radiation therapy can vary from person to person, so it is important to discuss all treatment options and their pros and cons with a doctor.

Like many cancer treatments, radiation therapy can have side effects. However, there are strategies to help manage them and improve quality of life.

Fatigue

Fatigue is one of the most common side effects of radiation. People who experience fatigue after radiation therapy can try:

  • balancing periods of activity with periods of rest
  • eating a nutritious, balanced diet
  • practicing mind-body techniques
  • meeting with a mental health professional to address the emotional impact of treatment

Nausea and vomiting

Radiation therapy may cause nausea or vomiting. These strategies may help, especially on treatment days:

  • using antiemetic medication
  • drinking plenty of fluids
  • avoiding foods that increase feelings of nausea
  • eating smaller, more frequent meals that are well-tolerated

Skin problems

Radiation therapy can cause mild skin reactions, including dryness, peeling, redness, swelling, or sores. These strategies may help address skin issues:

  • using mild skin products
  • moisturizing the skin
  • protecting the skin from the sun

Hair loss

Radiation therapy may cause hair loss on the part of the body that receives treatment. These strategies may help manage hair loss:

  • treating the hair gently
  • using a mild shampoo
  • protecting the scalp from the sun

Doctors have developed many sophisticated types of radiation therapy for NSCLC. Its effectiveness depends on the cancer stage, but can help improve survival, quality of life, and overall outcomes.

Common side effects of radiation therapy include fatigue, nausea and vomiting, skin changes, and hair loss, though these can often be managed with guidance from a doctor.

Ultimately, a person and their doctor can work together weigh the risks and benefits of radiation therapy and determine if it is the right treatment.