When is radiation used in NSCLC?

Radiation therapy uses high-energy rays or particles to kill cancer cells. Depending on the stage of the non-small cell lung cancer (NSCLC) and other factors, radiation therapy might be used:

• As the main treatment (sometimes along with chemotherapy), especially if the lung tumor can’t be removed because of its size or location, if a person isn’t healthy enough for surgery, or if a person doesn’t want surgery.
• After surgery (alone or along with chemotherapy) to try to kill any small areas of cancer that surgery might have missed.
• Before surgery (usually along with chemotherapy) to try to shrink a lung tumor to make it easier to operate on.
• 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 radiation therapy 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 radiation therapy 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, radiation treatments to the lungs are 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 radiation therapy (3D-CRT) uses special computers to precisely map the tumor’s location. Radiation beams are then shaped and aimed at the tumor(s) from several directions, which makes it less likely to damage normal tissues.
  • Intensity modulated radiation therapy (IMRT) is a form of 3D therapy. Along with shaping the beams and aiming them at the tumor from several angles, the strength of the beams can be adjusted to limit the dose reaching nearby normal tissues. This technique is used most often if tumors are near important structures, such as the spinal cord.
  • Volumetric modulated arc therapy (VMAT) is a variation 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 radiation therapy that is given in only one session. It can sometimes be used instead of or along with surgery for single tumors that have spread to the brain. In one version of this treatment, a machine focuses about 200 beams of radiation on the tumor from different angles over a few minutes to hours. Your head is kept in the same position with a rigid frame. In another version, a linear accelerator (a machine that creates radiation) that is controlled by a computer moves around your head to deliver radiation to the tumor from many different angles. 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.