Radiotherapy to the whole lung for Ewings tumour in children
This page has been produced to provide information about radiotherapy to the whole lung for Ewings tumours and aims to answer some of the questions often asked by patients and their carers.
We hope you will find this helpful.
We give radiation treatment (radiotherapy) in addition to surgery and chemotherapy because the disease may come back if we do not. The treatment has to be planned with great care and it is successful for many, but unfortunately not all, patients.
The total radiation dose has to be spread out to make the individual treatments safe. The total dose is kept low to avoid serious damage to the lungs. Fortunately Ewings tumour is very sensitive to irradiation, so that even a low dose is worthwhile treatment. We give treatment every day for about two weeks (usually excluding weekends and bank holidays). At each session, the patient spends about ten minutes in the treatment room but most of this time is spent getting him/her into the right position.
Radiotherapy does not hurt, the machine does not touch the patient and it is rather like having an ordinary x-ray. We have to treat the whole area accurately, which means that the patient must lie very still, usually on their back. Lying still can be very difficult for some children, particularly young ones, so occasionally we have to use a general anaesthetic. A buzzing noise may be heard when the machine is working.
There are usually mild side effects. We can relieve most of them but sometimes not completely. Some of the side effects happen immediately, some of them happen soon after we finish treatment and some take a longer time to show.
Immediate side effects
A mild discomfort in the gullet (oesophagus) may occur when eating or drinking; this can be treated and will go away within a few days of finishing treatment.
Nausea and vomiting only occasionally occur with this treatment and can usually be well controlled with anti-sickness drugs.
Side effects after treatment
Long-term side effects
These are the hardest to predict and unfortunately, when they do happen, they are permanent.
It is possible for lung function to be affected by radiation treatment. Special lung studies might show some abnormality even after a low dose of irradiation, although symptoms may never occur. It is important that anyone who has received this treatment never smokes.
The radiation may affect the growth of the back bones and ribs in the radiation area. There might be some underdevelopment of the bones but this is unlikely as the radiation dose is low and no effect on overall height is expected.
The heart is also treated at the same time as the lung. The radiation dose is very small and is unlikely to damage the heart but one of the chemotherapy drugs (doxorubicin) can damage the heart. Some treated children show a tendency to heart failure later in life. This may occur under stressful conditions, such as pregnancy, labour or hallucinogenic drugs. During pregnancy it is important that the medical staff know about the cancer treatment and that maternity care and delivery are in hospital. The heart is also damaged by smoking and it is very important to avoid smoking.
The thyroid gland (in the low neck) can be affected by radiation. It may become underactive or occasionally overactive even many years after treatment. Both these conditions are detectable on blood tests and can be treated.
Breast development may be reduced by the treatment, this will occur in a symmetrical way. Plastic surgery to build up breast tissue is possible later but is rarely necessary. We also know that lactation (milk production) can be reduced by radiotherapy, this can affect breast feeding.
We are finding that, very rarely, children who have had treatment for one tumour can develop another type of tumour some years later. Smoking significantly increases the risks of developing many tumours.
During follow-up we will be looking out for all of these problems.
Leaflet to download
You can download a PDF leaflet with the information on this page: