Side Effects
In general the treatment of lung cancer with external beam radiation therapy is very well tolerated. Symptoms directly related to the treatments do develop slowly over time during the course of therapy. The frequency and severity of these symptoms depend on a combination of diverse factors which may diminish or increase their intensity.
These factors include the following:
General performance status
This is by far one of the most important predictors of how a patient will fair through a course of radiation therapy. Patients without symptoms or with minimal symptoms related to their lung cancer and with good nutritional status fair the best. Patients who are debilitated, with cancer related symptoms (significant weight loss, airway obstruction, bleeding, pneumonia, etc.) will fair less favorably through the course of therapy. There are detailed scales to grade the performance status of each individual patient at the time of initial evaluation before treatment starts. Corrective measures to increase performance are implemented when indicated.
Co-morbid conditions
Patients with severe emphysema, heart failure, uncontrolled diabetes, etc. are more prone to tolerate radiation treatments less favorably. However with the newer techniques of treatment delivery which decrease the volumes of lung and other critical organs exposed to radiation, tolerance to treatment has improved.
Concurrent chemotherapy and radiation therapy
Many patients require systemic chemotherapy and radiation therapy at the same time. This combination acts beneficially to enhance the effectiveness of radiation on the cancer sites targeted, but at the same time it also enhances the frequency and severity of side effects.
Radiation treatment factors
The location and extent of cancer bearing sites will determine the volume of lung and others tissues exposed to radiation. The larger the volume, the more side effects and vice versa.
Type and stage of cancer: It will determine how much radiation is required to treat the cancer. Higher doses will give more symptoms and vice versa.
Critical organs (normal organs) that cannot be avoided due to proximity to the cancer and therefore are included in the radiation field. The most common critical organ that gives most of the acute side effects during the course of radiation therapy is the esophagus (food pipe). Radiation irritates the lining of the esophagus which causes difficult and/or painful swallowing of food and liquids. The severity of this side effect varies from mild to severe. Medications are prescribed to help this side effect when indicated. It is a temporary reaction which subsides a few days after the treatments are completed.
Scarring of the lung that has been exposed to radiation in the vicinity of the cancer causes the loss of lung function to various degrees two to three months after completion of therapy. This is an irreversible condition which may or may not affect the patient%u2019s breathing. The total volume of lung included in the radiation field and the overall pulmonary reserve predict for the severity of this side effect.
State of the art planning and delivery systems such as respiratory gating and IGRT (image guided radiation therapy) minimize the volumes of normal lung exposed to radiation and therefore minimize this and other untoward effects of therapy.
Detailed expectations regarding treatment benefits and side effects are discussed with patients and relatives for their individual situations during the initial consultation and evaluation and are reaffirmed regularly during the course of their therapy.
These factors include the following:
General performance status
This is by far one of the most important predictors of how a patient will fair through a course of radiation therapy. Patients without symptoms or with minimal symptoms related to their lung cancer and with good nutritional status fair the best. Patients who are debilitated, with cancer related symptoms (significant weight loss, airway obstruction, bleeding, pneumonia, etc.) will fair less favorably through the course of therapy. There are detailed scales to grade the performance status of each individual patient at the time of initial evaluation before treatment starts. Corrective measures to increase performance are implemented when indicated.
Co-morbid conditions
Patients with severe emphysema, heart failure, uncontrolled diabetes, etc. are more prone to tolerate radiation treatments less favorably. However with the newer techniques of treatment delivery which decrease the volumes of lung and other critical organs exposed to radiation, tolerance to treatment has improved.
Concurrent chemotherapy and radiation therapy
Many patients require systemic chemotherapy and radiation therapy at the same time. This combination acts beneficially to enhance the effectiveness of radiation on the cancer sites targeted, but at the same time it also enhances the frequency and severity of side effects.
Radiation treatment factors
The location and extent of cancer bearing sites will determine the volume of lung and others tissues exposed to radiation. The larger the volume, the more side effects and vice versa.
Type and stage of cancer: It will determine how much radiation is required to treat the cancer. Higher doses will give more symptoms and vice versa.
Critical organs (normal organs) that cannot be avoided due to proximity to the cancer and therefore are included in the radiation field. The most common critical organ that gives most of the acute side effects during the course of radiation therapy is the esophagus (food pipe). Radiation irritates the lining of the esophagus which causes difficult and/or painful swallowing of food and liquids. The severity of this side effect varies from mild to severe. Medications are prescribed to help this side effect when indicated. It is a temporary reaction which subsides a few days after the treatments are completed.
Scarring of the lung that has been exposed to radiation in the vicinity of the cancer causes the loss of lung function to various degrees two to three months after completion of therapy. This is an irreversible condition which may or may not affect the patient%u2019s breathing. The total volume of lung included in the radiation field and the overall pulmonary reserve predict for the severity of this side effect.
State of the art planning and delivery systems such as respiratory gating and IGRT (image guided radiation therapy) minimize the volumes of normal lung exposed to radiation and therefore minimize this and other untoward effects of therapy.
Detailed expectations regarding treatment benefits and side effects are discussed with patients and relatives for their individual situations during the initial consultation and evaluation and are reaffirmed regularly during the course of their therapy.