Ask a clinical oncologist: What are the side effects of radiotherapy for lung cancer?

Before you agree to any anti-cancer treatment, it is important to have a good understanding of the procedure and the possible side effects.

Here, Dr Tony Mathew, renowned consultant clinical oncologist, provides an expert insight into the possible side effects that may occur with radiotherapy for lung cancer.

What are the short-term side effects of lung cancer radiotherapy?

Short-term side effects of lung cancer radiotherapy can occur during treatment or soon (weeks) after treatment.

• Tiredness (fatigue)

Almost everyone having radiotherapy will feel more tired than usual, particularly towards the end of treatment. This tiredness may continue for a number of weeks after the completion of treatment. It is completely right to rest when you feel the need to do so.

• Chest problems

Chest discomfort is common with radiotherapy, and analgesics are advised as a result. Sometimes, blood and debris may be coughed up during or after treatment.

Shortness of breath, which can also be an issue, can worsen during treatment. However, it generally settles down shortly after treatment along with increased mucus (phlegm).

• Swallowing difficulties

Part of the oesophagus (gullet), which is a muscular tube that takes food to the stomach, could be included in the treatment area.

Radiotherapy to this area can cause a sensation of burning and discomfort behind the sternum, discomfort or pain on swallowing, as well as a sensation of difficulty swallowing and food sticking. This may require you to alter your diet or (temporarily) need to eat softer foods and see a dietitian to be prescribed supplements to ensure that you are getting adequate nutrition.

Any swallowing difficulties that may be experienced are expected to be temporary. Patients are expected to be able to get back to eating a normal diet after treatment.

• Skin reactions

It is possible that you will get a mild reaction affecting the area of skin where the radiotherapy is aimed. For this reason, you will receive information about skincare at the start of your treatment.

As well as skin reactions, hair loss may also occur within the treated area. You may lose some of the hairs on your chest, but the hair on your head will not be affected.

What are the long-term side effects of lung cancer radiotherapy?

Long-term side effects of lung cancer radiotherapy develop more than three months after the completion of treatment. If these side effects develop, they can become permanent.

• Radiation fibrosis

Scarring of the lung (fibrosis) on the treated area can develop after treatment, resulting in shortness of breath and a chronic cough. Rarely, you will require oxygen at home to help with your breathing.

• Stricture

Narrowing of the oesophagus (stricture) can develop several months or a year after treatment, making it difficult to swallow food. Oesophageal stricture may require a procedure to dilate (open) the oesophagus to help you to eat normally.

• Radiation-induced heart disease

It is believed there may be some risk of damage to the heart when radiotherapy is used to treat lung cancer, known as radiation-induced heart disease.

Radiation-induced heart disease could include the development of an abnormal heart rhythm, failure of the heart to pump blood properly, or damage to the coronary arteries (which are the vessels that supply blood to the heart muscle). Rarely, these complications could lead to a heart attack.

• Skin changes

The skin can look different in the treated area and feel tougher. You may notice pigment changes and the development of small blood vessels on the surface of the skin.

• Fractures

There is an increased risk of rib fracture after radiotherapy, which would be treated with rest and pain relief medication.

Additionally, there can also be fracture of the back bones of the spine (the vertebrae) due to these being weakened by radiotherapy. However, these would only affect the vertebrae that are in involved in the radiotherapy treatment. This type of fracture would usually be treated with pain relief medication.

For patients with additional risk factors for reduced bone strength, it may be considered appropriate to prescribe bone strengthening medication to help prevent future fractures from occurring.

• Second malignancy

In the long-term, there may be a slight increased risk of developing a new cancer caused by the treatment. Despite this, it is considered at large that the benefits of receiving treatment far outweigh any potential future risk. If you are concerned, it is important to speak with your medical team about this.

If you have any additional needs (including physical, religious, cultural, emotional or medical) after having reviewed what lung cancer radiotherapy entails, it is important that you inform your medical team so that every effort can be made to meet them.

If you require radiotherapy for lung cancer, do not hesitate to book an appointment with Dr Mathew via his Top Doctors profile today to discuss your options and any concerns you may have.