Radiation is a common and effective treatment for some stages of lung cancer. Still, there’s a risk of serious side effects, some of which may not show up for years. A doctor can help you weigh the benefits with the risks.

Radiation therapy uses high-energy X-rays to destroy cancer cells or prevent them from spreading. Your medical team may use radiation alone or with other lung cancer treatments such as chemotherapy. Radiation can be used before or after surgery. Sometimes, doctors use radiation to relieve lung cancer symptoms.

There are many types of radiation therapy. Newer technologies can target lung tumors more directly and avoid harming healthy body tissue.

Radiation therapy is typically painless, but there may be side effects. A doctor can help you understand the best ways to manage them.

A doctor will consider radiation therapy depending on the stage of your lung cancer, your health, and your treatment goals.

Your doctor might recommend radiation therapy:

  • as your main treatment, given alone or with chemotherapy
  • before surgery to help shrink the tumor
  • during or after surgery to destroy any cancer cells that may remain
  • to relieve symptoms such as pain or trouble breathing from a tumor obstructing an airway
  • to lower the chances of cancer spreading outside your lungs

Doctors don’t typically recommend radiation if your lung cancer is in the very early stages. In this case, you may only need surgery to remove the cancerous part of your lung.

But a doctor may recommend radiation instead of surgery if they think surgery would be too risky due to your age or underlying conditions.

Radiation works by damaging the DNA inside cancer cells. There are two general types of radiation therapy:

  • External radiation therapy: A large machine directs radiation waves to the tumors from outside your body.
  • Internal radiation therapy: Doctors implant a small radioactive source in your body near the cancer site.

There are also several types of external and internal radiation therapy.

External beam radiation therapy (EBRT)

External beam radiation therapy (EBRT) uses a large machine outside your body and focuses radiation waves on the cancer site.

EBRT is like getting an X-ray but with a stronger dose of radiation. A typical course of EBRT to the lungs is 5 days a week for 5 to 7 weeks. Each treatment only lasts a few minutes.

Stereotactic body radiation therapy (SBRT)/stereotactic ablative radiotherapy (SABR)

Stereotactic body radiation therapy (SBRT) is a type of external radiation. It’s also known as stereotactic ablative radiotherapy (SABR).

Doctors typically use SBRT for lung cancer in the early stages when surgery isn’t a good option.

SBRT uses highly focused beams of high dose radiation aimed at the tumor from different angles. You go into a specially designed body frame to help minimize movement of the lung tumor while you breathe.

Depending on the company that makes the machine, SBRT may also be called:

  • X-Knife
  • CyberKnife
  • TrueBeam
  • Gamma Knife

Despite some of these names, SBRT isn’t a surgery and doesn’t involve any cutting.

Intensity-modulated radiation therapy (IMRT)

Intensity-modulated radiation therapy is a form of 3D therapy. This newer technology allows your doctor to shape and adjust the beams to be able to aim them at the tumor from several angles.

A doctor might choose this technique if lung tumors are near important structures such as your spinal cord.

Stereotactic radiosurgery (SRS)

Stereotactic radiosurgery (SRS) is a type of external radiation therapy in which a machine focuses about 200 beams of radiation on the tumor from many angles.

SRS usually takes one session. Doctors sometimes use it along with surgery for single tumors that have spread to your brain.

Intraoperative radiation therapy (IORT)

Intraoperative radiation therapy is a type of external radiation doctors perform during surgery to remove tumors.

It directs the beams of radiation directly to the tumor. During the surgery, the surgeon can move healthy tissues away from the tumor to protect them while you undergo radiation.

Brachytherapy

Brachytherapy is a type of internal radiation therapy. Doctors implant a radioactive material directly in or next to the cancer using a thin tube known as a bronchoscope. The radiation source may be in the form of capsules, small pellets, or steel seeds about the size of a grain of rice.

The radiation is limited to the tissue right next to the source. After some time, your medical team will remove the radiation source.

Doctors sometimes use brachytherapy to reduce the size of tumors in your airway to make it easier to breathe.

Every person reacts to radiation therapy differently.

Some side effects occur at the time of treatment or just after. But you may also experience long-term side effects months or years after radiation.

Short-term side effects

Early side effects of radiation to your chest tend to be mild and treatable. They may include:

Long-term side effects

Late, long-term side effects can take months or even years to develop. They may include:

  • heart complications
  • damage to your lungs (radiation pneumonitis)
  • chest pain
  • shortness of breath that gets worse with exercise

Can radiation therapy cause other cancers?

Radiation therapy can increase your risk of developing a second cancer. These cancers may develop 10 years or more after radiation therapy.

Other treatments for lung cancer include:

How effective is radiation therapy at treating lung cancer?

Radiation therapy can effectively eliminate tumors at specific sites in your body or control the spread of lung cancer. It can also help ease symptoms and improve your quality of life.

Newer technologies, such as SABR, can also improve your outlook compared with older radiation technology.

Does radiation therapy make me radioactive?

Internal radiation therapy, such as brachytherapy, can make you radioactive. Though the risks are minimal, your doctor will ask you to reduce physical contact with other people, especially children and pregnant people.

You’re only radioactive while the source is in place. Most people stay in the hospital or radiotherapy facility for as long as the source is in place.

External radiation therapy doesn’t make you radioactive at any time during or after treatment.

How does the cost of radiation therapy compare to other options?

Compared with other options, such as surgery and chemotherapy, the costs of radiation therapy vary depending on the type and duration of treatment, the hospital or facility you visit, your insurance coverage, and many other factors.

According to a 2018 study, lung cancer surgery has the highest initial costs compared with chemotherapy and radiation for people enrolled in Medicare. But over the course of treatment, chemotherapy tends to cost more than radiation and surgery.

Radiation therapy is a powerful and commonly used tool for treating lung cancer. Your medical team may use radiation on its own, before or after surgery, or along with other treatments such as chemotherapy. Advancements in technology and its delivery have helped lower side effects and improve outcomes.

To manage side effects, ask your doctor to refer you to a palliative care specialist.