Side Effects of Radiation Therapy for Lung Cancer

photo of a man with a red blistering skin from a side effect of radiation therapy
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Radiation therapy is used in many ways for people with lung cancer and may be used to reduce the chance of a recurrence, with a curative intent (as with SBRT), or as a way to reduce pain or fractures in advanced stage disease. While benefits often outweigh risks, there are both short-term It is good to keep in mind the benefits of treatment when looking at possible side effects and to discuss these with your radiation oncologist.

and long-term side effects which may occur. What are these common side effects and what might you expect?

Short-Term and Long-Term

Everyone responds to radiation therapy for lung cancer differently. The location of your cancer, your general health, and other treatments you are receiving such as chemotherapy all play a role in how you will feel during your treatment. Some people notice very few symptoms, whereas others find these symptoms more bothersome.

Radiation therapy is a local treatment, and therefore most symptoms arise in the area that is being treated. In the case of lung cancer, it is the chest (or brain or bones when it's used for metastatic disease). New technology is allowing radiation to be delivered more precisely to tumors, lowering the chance that side effects will occur. Studies are in process to develop further ways to protect healthy cells against radiation.

Short-term side effects often show up within the first few weeks of treatment and many resolve soon after treatment is completed.

Long-term side effects can sometimes appear months or even years after treatment. It is good to keep in mind the benefits of treatment when looking at possible side effects and to discuss these with your radiation oncologist.

Let's break these down into symptoms you may experience right away, and those which you should be aware of down the line.

At the bottom of the page, we provide a link to information on how to manage all of these symptoms.

Short-Term Side Effects

Short-term side effects often begin within a few weeks after you start radiation therapy. Even if your radiation oncologist has told you that you may experience these symptoms, make sure you let her know if they occur.

Skin Irritation 

A few weeks after beginning radiation therapy your skin overlying the treatment area may become red and irritated. This is sometimes followed by dryness and peeling two to three weeks later. As your skin heals, it may appear darker, like a suntan. Skin irritation usually resolves within a few weeks of finishing therapy, although some darkening of your skin may remain. Special care should be given to avoid sunburn. Limiting the use of lotions and creams that may contain irritating chemicals, and avoiding extremes of hot or cold is important to prevent further irritation to your skin.

Radiation recall is an inflammatory reaction which sometimes occurs when people are receiving radiation therapy and chemotherapy together. Occurring in roughly 10 percent of people receiving these treatments simultaneously, it may have the appearance of a severe sunburn with blistering, extreme redness of the skin, and swelling.

 

Hair Loss

Hair loss may occur in the region where you receive radiation, whether your chest as with lung cancer or your head if you are being treated for brain metastases. Unlike chemotherapy-induced hair loss, the loss of hair from radiation therapy is often permanent.

Cough/Shortness of Breath

Radiation therapy lowers the level of the lung's surfactant, a substance that helps the alveoli in the lungs expand. This can result in a dry cough or shortness of breath. Occasionally, steroids are given to ease these symptoms. Shortness of breath and a cough accompanied by a fever may also be a sign of radiation pneumonitis (see below).

Fatigue

Most people feel some degree of fatigue during radiation therapy and it can be severe. Fatigue usually begins a few weeks after the start of therapy and tends to worsen with time. It usually subsides six to eight weeks after you complete therapy. Many people are able to continue their daily routine during radiation therapy, but it is important to get plenty of sleep at night and allow yourself rest periods during the day as you need. There are many ways in which cancer treatments or the cancer itself can cause fatigue.

Esophagitis

Since the esophagus (the tube leading from the mouth to the stomach) travels through the chest, radiation to the lungs can cause it to become irritated. Pain or difficulty with swallowing, heartburn, or a sensation of a lump in your throat may occur. Symptoms usually begin two to three weeks after starting therapy and subside a few weeks after completing treatments.

Long-Term Side Effects

Long-term side effects may also occur following radiation therapy. Since some of these may not begin for weeks or years after your treatments are completed, it's important to be aware of these and talk to your doctor if you have any symptoms.

Radiation Pneumonitis

Radiation pneumonitis is an inflammatory response of the lungs to radiation which can occur 1 to 6 months following the completion of radiation treatments. It is fairly common, affecting 5 to 15 percent of people who have radiation for lung cancer. Symptoms include a fever, cough, shortness of breath, and is diagnosed based on particular changes seen on a chest x-ray. Since having lung cancer alone may result in a cough and shortness of breath, it's important to have a high index of suspicion if you note any changes.

The treatment for radiation pneumonitis is often a short course of steroids (corticosteroids such as prednisone). Most of the time the condition resolves over time, but without treatment may progress to pulmonary fibrosis.

Pulmonary Fibrosis

Pulmonary fibrosis refers to the formation of scar tissue in the lungs that can occur for many reasons, including radiation therapy for lung cancer and radiation pneumonitis. Symptoms include shortness of breath and a decreased ability to exercise.

Cardiac Toxicity

Radiation therapy can affect your heart in several different ways. Most commonly it causes damage to the heart muscle (cardiomyopathy) which results in the heart being unable to pump blood to the rest of the body as before. This is most common when high doses of radiation are used for tumors and lymph nodes involving the mediastinum, the area between the lungs near the heart. Radiation therapy can also increase your risk of coronary artery disease, valve disease, or abnormal heart rhythms.

Pericardial Effusion

Radiation damage to the tissues lining the heart (pericardium) can result in a build-up of fluid between these layers. When it occurs chronically it may cause shortness of breath and can be hard to distinguish from other side effects or the cancer itself. When a pericardial effusion occurs rapidly, symptoms may be severe due to a greatly reduced ability for the heart to pump blood. (In essence, the heart gets squeezed in tightly).

Secondary Cancers

A potential side effect of radiation therapy is the occurrence of a second cancer down the line due to the cancer-causing (carcinogen) effect of radiation. With lung cancer, leukemia can occur rarely as a second cancer 5 to 10 years after completing therapy. Secondary cancers involving the lung or breast can also occur, usually appearing at least 10 years after treatment.

Bottom Line

Both short-term and long-term side effects may occur when you have radiation therapy for lung cancer. Most commonly these side effects are more of a nuisance, with skin irritation and fatigue occurring for many people. Other side effects may be more serious and require that you and your doctor have an awareness that they may occur, and do further testing if you have symptoms.

There are many things you can do to help manage the adverse effects. Learn about treatment options when these complications occur and how to manage the side effects of radiation therapy.

Sources:

American Society of Clinical Oncology. Cancer.Net. Side Effects of Radiation Therapy. Updated 12/16. https://www.cancer.net/navigating-cancer-care/how-cancer-treated/radiation-therapy/side-effects-radiation-therapy

Pass, Harvey I. Principles and Practice of Lung Cancer: The Official Reference Text of the IASLC. Philadelphia: Wolters Kluwer Health/Lippincott Williams & Wilkins, 2010. Print.

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