Royal Prince Alfred Hospital Royal Prince Alfred Hospital
Radiation Oncology

Radiotherapy for Lung Cancer

Radiotherapy plays a vital role in the treatment and management of lung cancer. It is commonly used together with surgery and chemotherapy. In some cases Radiotherapy may be used alone instead of surgery.

The treatment course received by a patient depends on a variety of factors; including the type of tumour (histology), location, stage of the disease, your general health and age.
Your Radiation Oncologist will advise you what regime is most suitable for you, how effective the therapy will be and how the treatment will affect you.
What should you bring to Planning?
  • A referral letter from your doctor (if not already submitted)
  • Medicare card
  • Any private scans that you have had
  • A list of your current medications
What happens during Planning?
When you come into the Radiation Oncology Department, please report to the reception area. You will be guided to the waiting room where you will be met by your Radiation Therapists. Your Radiation Therapists will introduce themselves and ask you to confirm your identity by asking you to state:
  • your full name,
  • date of birth, and
  • the body site you will be having treatment to
You will find that this identification process is repeated multiple times during your treatment. This is because correct identification of patients is crucial to ensure that the correct treatment is given to the correct patient.
After correct identification, your Radiation Therapist will briefly explain the planning procedure and give you the opportunity to ask questions. You will then be shown to the change rooms to change into a gown. You will then be escorted to the Radiotherapy Simulation and Planning area where your Radiation Therapists will position you on the CT scanner bed.
Typically you will be lying on your back with your arms up above your head. It is important that you are stable and comfortable in this position for the duration of your Radiotherapy Planning (up to 30 mins) and later for each of your Radiotherapy sessions. 
Contrast is used for patients having treatment to the lung to assist the doctor with locating the treatment target volume. The contrast is given through a tube that is placed into your arm by a qualified nurse. The nurse will do this prior to the Radiation Therapists positioning you.
The Radiation Therapists will also ensure that you are lying as straight as possible on the CT scanner bed. They will do this using the lasers situated in the CT scanner room. This process will also be repeated at each of Radiotherapy sessions. 
Once your Radiation Therapists have positioned you, they will draw some marks on your skin. 
You will then undergo a CT scan in the treatment position. It is very important that you breathe normally and lie very still during the CT scan as any movement can affect the quality of the scans and you may then need to have the scans repeated.
Once the scan is complete, your Radiation Therapists will make three of the marks on your skin permanent  with tattoos. This is done so they can use these marks as a reference to position you in exactly the same way for each day of your Radiotherapy. The tattoos are permanent and will be approximately the size of a small freckle. They will be made with a shallow skin prick using a sterile needle and a dab of black ink. In the long term they will appear as black or blue dot. 
Your Radiation Therapists will then take photos of the area to be treated and your face for identification purposes. These will be attached to your treatment plan and medical records.
Your Radiation Oncologist will be present during the planning session which takes approximately 30-45 minutes.
At the end of the Radiotherapy Planning session you will be given an appointment card which will contain details of your first treatment (date and time).
Your Radiation Therapist will then escort you back to the change rooms. When you have collected all of your belongings, your Radiation Therapist will show you the location of the treatment waiting room. This is where you will wait for your treatment every day once Radiotherapy starts.
You will also be shown how to scan your card at the front desk barcode scanner which you will use every day when you arrive for treatment. This is how you will notify the treatment staff of your arrival in the Department.
What happens during treatment?
When you come in for your first treatment, you will need to scan your card at the front desk and take a seat in the waiting room.
One of your Radiation Therapists will call your name when they are ready to treat you.
Your Radiation Therapist will introduce themselves and ask you to confirm your identity by asking you to state:
  • your full name,
  • date of birth, and
  • the body site you will be having treatment to.
Your Radiation Therapist will then sit down with you to discuss the treatment process, and expected side effects relating to your treatment. You will have already discussed side effects with your Radiation Oncologist but if you have any questions please feel free to ask your Radiation Therapist who will answer your questions to the best of their knowledge. If necessary they will refer you to the appropriate member of your treatment team who can provide you with further information. 
Your Radiation Therapist will take you to your treatment room and you will be asked to lie on the treatment bed in the same position as you were in your planning session.
Your Radiation Therapists will then dim the lights so that the laser beams in the room can be seen clearly. These will be used to guide the radiation therapists in setting you up in the exact same position every day.

 Patient receiving Radiotherapy 

Your radiation therapists may feel for your bones and move you slightly when they are setting you up. It is important that you do not try to help unless asked as usually only millimetre adjustments will be made.
The bed and machine will then be moved into the treatment position. The machine may come close to you, but will not touch you at any point during the treatment process.
When your Radiation Therapists are ready to turn the machine on, they will let you know and then leave the room. You will hear a doorbell sound as they leave.
Just stay nice and still and breathe normally.
There are cameras and a microphone inside the room and your Radiation Therapists will use these to monitor you throughout the treatment. If you need your Radiation Therapists for any reason, wave your hand or call out and your Radiation Therapists will come straight in.
When the treatment is over, your Radiation Therapist will come back into the room and assist you off the bed.
Although the actual treatment only takes a few minutes, the whole treatment session (from positioning to finishing treatment) may take about 10-20 minutes each day.
During the course of Radiotherapy, you will see your Radiation Oncologist or another doctor on your treatment team once a week on a set review day. This is important as it allows them to monitor your progress and address any concerns you may have about your treatment. Please allow for more time on this review day as your visit to the hospital will be slightly longer.
Due to individual treatment regimes and medical circumstances, side effects will vary from person to person and are specific to your customised plan.
Your doctor will see you once a week during your treatment to monitor your progress and help you manage any side effects.
If you have any problems in between these visits please speak to your radiation therapist who will contact your doctor for you as needed.
Some of the possible side effects are listed in the table below. These side effects usually occur one week into treatment or may appear during the course of your treatment.
Many of these side effects can be managed and will gradually disappear after your treatment has finished.
Please let your treating team know if you develop any of these symptoms so they can be managed and you are more comfortable.

     Side effects
     What can help? 
     Fatigue (tiredness)
     Most patients experience reduced energy levels, tiredness and      lack of motivation soon after starting treatment. Just listen to      your body and rest if needed.  
     Dry, red, itchy skin (in      the treatment area)
     Skin reactions tend to appear after about two weeks of      treatment and may develop even further to become itchy and      tender as the treatment continues.
     The skin reaction is similar to that of sunburn; it may become      pink, and may feel warm to touch with mild discomfort.
  • Avoid sun exposure (to the treated area)
  • Use a mild or moisturising soap in the treatment area
  • Bathe using lukewarm water, and avoid scrubbing in the treatment area.
  • Avoid irritant products containing alcohol, perfumes or additives and products containing Alpha Hydroxy Acids (AHA) as this can increase skin irritation. If you are unsure of whether or not to use a product, feel free to ask the nurses or doctor.
  • Apply simple body lotions or creams on affected area at least once daily. Sorbolene moisturiser with gylcerin is recommended.
  • Your doctor may prescribe creams/ ointments to help relieve severe itchiness
     Pain and discomfort      on swallowing and      eating
  • It is recommended to use salt and sodium bicarbonate mouthwash.
  • Soluble paracetamol gargles are used to relieve pain to the throat and mouth.
  • If required your doctor can prescribe xylocaine viscous a local anaesthetic or medication.
     Increased coughing      and mucous      production

There are some uncommon side effects that may occur months or years after treatment. These are called late effects and may include the following:
  • Lung scarring
  • Inflammation of the lungs
  • Cardiac toxicity
[Any further concerns speak to your doctor or nursing staff in the department]
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