Thoracic Oncology Program

Lung Cancer

Chemotherapy and Radiation Therapy

Radiation Therapy

Radiation therapy will help shrink your tumor. This therapy uses a form of high energy x-rays which are carefully directed at your tumor and the surrounding tissue which is at high risk for local spread. The high-energy beams can kill cells and keep them from dividing and spreading. This helps destroy the tumor, because cancer cells divide and grow faster than normal cells. Normal cells usually recover successfully from radiation, but the high-energy beams will be carefully aimed to target your tumor and lymph nodes and minimize the amount of normal tissue affected.

Your initial appointment in the Radiation Oncology Department will be used to create a treatment field, this is known as simulation. A custom set of "blocks" will be designed that allow us to treat your cancer while protecting your healthy tissue & organs. These blocks will be placed between you and the radiation machine during each treatment session. You will not feel the radiation while it is being delivered, and the actual treatment will take less than 5 minutes. Expect to be in the department for 15 to 30 minutes once or twice each day, though, so that the machine can be properly set up for your individual needs.

Schedule

Simulation - a 1 hour appointment (a second appointment for check films may be needed)
Radiation therapy - daily appointment, approximately 30 minutes for a total of 5 to 6 weeks, depending on the dose.
A CT scan will be performed in the third week of therapy. This scan is for treatment planning purposes only and will not be used to evaluate tumor shrinkage.

Side Effects

Fatigue - you may feel very tired, particularly during the last several weeks of therapy. Your body is working hard to fight the cancer, give it what it needs - REST! While you may continue most activities during therapy, do not overdo it. Depending on your job, you may continue to work full time, part time or you may need to take some time off.
Skin Changes - your skin may become very dry, irritated and red within your treatment field. Treat this area gently. Avoid using powders, lotions or creams not prescribed by your doctor on this area.
Hair loss - you will lose the hair on your chest that is within the treatment field. This hair will most likely grow back later, after the radiation treatments have stopped.

Chemotherapy

Chemotherapy refers to medications that are used to treat cancer. There are many different types of chemotherapy. Most of the drugs used in the treatment of lung cancer either directly kill cancer cells or stop them from dividing into new cells. Your Medical Oncologist will make recommendations for the specific chemotherapy medication you will receive based on your stage of disease, overall physical health and any prior treatments. The exact doses will be calculated using your weight, height and lab values. You will see the doctor or nurse practitioner in the clinic. You will receive your chemotherapy as an outpatient in the Stoler Pavilion Infusion area, specifically dedicated to outpatient chemotherapy. You will be given medicine to prevent nausea and allergic reactions before your chemotherapy. A specially trained nurse will remain with you while your chemotherapy is infusing.

Everyone reacts to the chemotherapy differently. Common side effects of chemotherapy drugs used to treat lung cancer include nausea, vomiting, diarrhea or constipation, fatigue, hair loss and decreased electrolyte and blood cell counts. You will be given medicines to relieve and minimize these effects. Adjustments to your chemotherapy dose may be necessary if the side effects are severe.

Common Side Effects:

Fatigue - you may feel very tired, particularly during the last several weeks of therapy. Your body is working hard to fight the cancer, give it what it needs, REST! While your may continue most activities during therapy, do not overdo it. Depending on your job, you may continue to work full time, part time or you may need to take some time off.
Hair loss - some of the chemotherapy agents (Taxol, Taxotere, and others) cause temporary hair loss. The hair will grow back once the chemotherapy treatments are over. Some insurance plans will cover the cost of a wig.
Decreased appetite - this may be related to fatigue, nausea, or a change in your sense of taste from the chemotherapy. In addition to eating whatever foods appeal to you, try to drink 3-4 cans of supplements (such as Boost, Ensure, Scandishake, etc.) each day. Make milkshakes with the supplements, add your favorite candy, peanut butter, whatever - be creative & add lots of calories! If you notice tenderness or sores in your mouth or lips please let us know.
Nausea - You may have some nausea at times throughout your treatment. If the medication you have been given doesn't help ease this, or if you are vomiting, please contact us.
Bone marrow suppression - this is also referred to as low blood cell counts. You will have blood drawn before each chemo treatment and sometimes in between treatments to make sure your blood cell counts are not too low. There are several types of cells that may be affected:
- White blood cells - these cells help fight infection. Chemotherapy can deplete your body of these cells. The normal level is at least 4,000, but while you are receiving chemotherapy, we expect it to be lower. If the count is too low (below 1,000-1,200), we will likely have you skip that day's treatment or postpone therapy for a week until your white blood cell count rises. In some cases, a daily injection called GCSF or Neupogen is given for 5-7 days after chemotherapy to help your body make more white blood cells.
- Platelet - these cells help form clots and prevent bleeding. Chemotherapy can also deplete the number of these cells. The normal platelet count is at least 130,000, but while you are receiving chemotherapy, it may be lower. If your platelet count is less than 100,000 on a treatment day, we will likely have you skip treatment or postpone it for a week. If your platelet level is too low and you are having abnormal bleeding (such as nosebleeds or bleeding gums), we may recommend a platelet transfusion.
- Hematocrit - this number refers to the amount of red blood cells you have circulating in your blood and how much room is available for carrying oxygen. When this level is low, your may feel very tired and have little or no energy. If it is too low, we may prescribe iron tablets or a weekly injection called Epogen or Procrit. If the level is very low (below 25) and you are having symptoms such as dizziness or weakness, we will likely recommend a blood transfusion.

This page was last updated on: March 3, 2008.