When is radiation used in NSCLC?

Radiation therapy (RT) uses forms of high energy to kill cancer cells.

Depending on things like the stage of the non-small cell lung cancer (NSCLC), RT might be used:

• As the main treatment. Sometimes RT is used with chemotherapy (chemo). Your doctor may offer this if your tumor can’t be removed because of its size or location, you aren’t fit enough for surgery, or you don’t want surgery.
• After surgery (alone or with chemo) to try to kill any small areas of cancer that surgery might have missed. This is called adjuvant RT.
• Before surgery (usually along with chemo) to try to shrink a lung tumor to make it easier to operate on. This is called neoadjuvant RT.
• To treat cancer spread to other areas, such as the brain or bone.
• To relieve (palliate) symptoms of advanced NSCLC, such as pain, bleeding, trouble swallowing, cough, or problems caused by spread to other organs, such as the brain.

There are 2 main types of RT that can be used to treat NSCLC:

• External beam radiation therapy (EBRT) focuses radiation from outside the body onto the cancer. This is the type of RT most often used to treat NSCLC or its spread to other organs. Treatment is much like getting an x-ray, but the radiation dose is stronger. The procedure itself is painless, and each treatment lasts only a few minutes. Most often, RT to the lungs is given 5 days a week for 5 to 7 weeks, but this can vary based on the type of EBRT and the reason it’s being given. There are different types of EBRT.
  
  • Three-dimensional conformal RT (3D-CRT)  maps the tumor’s exact location. Radiation beams are then shaped and aimed at the tumor(s) from many directions, which makes it less likely to damage normal tissues.
    
    • Intensity modulated radiation therapy (IMRT) is a form of 3D therapy. With IMRT, the strength of the beams can be adjusted to limit the dose reaching nearby normal tissues. IMRT is used most often if tumors are near important structures, such as the spinal cord.
      
      • Volumetric modulated arc therapy (VMAT) is a type of IMRT. It uses a machine that delivers radiation quickly as it rotates once around the body. This allows each treatment to be given over just a few minutes.
  • Stereotactic radiosurgery (SRS) isn’t really surgery, but a type of stereotactic RT that is given in only one session. It can sometimes be used alone, or with surgery, for single tumors that have spread to the brain. These treatments can be repeated if needed.
• Brachytherapy (internal radiation therapy) is sometimes used to shrink tumors in the airway to relieve symptoms. The doctor places a small source of radioactive material (often in the form of small pellets) directly into the cancer or into the airway next to the cancer. This is usually done through a bronchoscope, but it may also be done during surgery. The radiation travels only a short distance from the source, limiting the effects on surrounding healthy tissues. The radiation source is usually removed after a short time. Less often, small radioactive “seeds” are left in place permanently, and the radiation gets weaker over several weeks.