Head & Neck Cancer
Radiotherapy
Radiotherapy for head and neck cancer
Radiotherapy (also known as radiation therapy) together with surgery and chemotherapy are the three main treatments for head and neck cancer.
A multi-disciplinary team approach is used to determine the most suitable treatment, this team always includes an expert in radiotherapy called a radiation oncologist
How does radiotherapy work?
Radiotherapy uses a controlled dose of radiation to kill or damage cancer cells. The radiation oncology team directs the type of radiotherapy. For head and neck cancer, the radiation used is usually x-ray beams from an external machine. This is called EBRT which stands for external beam radiation therapy using an intensity modulated radiation therapy (IMRT) technique. This ensures the radiation is targeted precisely to the cancer. It reduces treatment time and minimises possible harm to nearby healthy tissue.
When radiotherapy is the main treatment for head and neck cancer
For certain pharyngeal (the pharynx or throat) and laryngeal (larynx or voice box) cancers, radiotherapy is used as the main treatment as a means of destroying cancer cells and helping the patient to maintain normal speech, swallowing, and breathing. In some instances, it will be used together with chemotherapy to make the radiation more effective.
Radiotherapy after surgery
As part of the treatment plan for head and neck cancer, radiotherapy if often used after surgery. When used in this manner, radiotherapy is known as adjuvant treatment. Its aim is to destroy any remaining cancer cells not removed by surgery and reduce the chance of the cancer returning. If radiotherapy is included in your treatment plan, it will usually be started once your surgical wounds have healed and your strength has recovered – generally within six weeks of your surgery. In some instances, chemotherapy will also be used as part of the adjuvant therapy.
Are there side effects of radiotherapy?
The side effects of radiotherapy for the treatment of head and neck cancer vary for each individual and is influenced by factors such as the number of sessions and whether it is combined with chemotherapy. Side effects are known to worsen 2-3 weeks from the end of the treatment and then start to improve. For some, side effects may last longer, be ongoing, or appear months or even years after treatment.
What are the possible side effects of radiotherapy?
The short-term side effects of radiotherapy for head and neck cancer can include:
- Fatigue
- Sores in the mouth
- Changes in taste
- Appetite loss
- Dry mouth and thick saliva
- Difficulty in swallowing
- Difficulty breathing
- Redness, burning and painful skin in the treatment area
- Weight loss
Longer-term or permanent side effects of radiotherapy for head and neck cancer may include:
- Dry mouth
- Thick saliva
- Difficulty in speech and swallowing
- Taste changes
- Fatigue
- Stiff muscles
- Swelling of the neck
- Mouth infection
- Hoarseness
- Hair loss
- Dental problems and tooth decay
- Appetite and weight loss
Other side effects can include:
- Aspiration - This is where fluid or food enters the windpipe while swallowing causing coughing and lung infections, and sometimes - difficulty breathing.
- Thyroid damage - If the thyroid is damaged during radiotherapy, it can cause an underactive thyroid, a condition known as hypothyroidism. This is managed with thyroid hormone replacement medication.
- Damaged blood vessels - This can reduce the blood supply to the area treated. In rare cases, this can cause the bone to start to die resulting in pain, infections, and fractures. This condition is known as osteoradionecrosis or ORN and is usually the result of dental work such as teeth removal after the radiotherapy treatment. Therefore, your radiotherapy team will instruct you to see a dentist prior to your radiotherapy so any dental issues can be treated before there is a risk of ORN. If you do need to visit your dentist after radiotherapy, it is very important that you advise them you have had this treatment before commencing any dental work.
Why is radiotherapy used for the treatment of head and neck cancer?
Radiotherapy is known for its particular effectiveness in the treatment of head and neck tumours. If you have been diagnosed with head and neck cancer, A/Prof McGuinness will discuss your treatment plan with you in detail to ensure you understand all aspects of the treatment as well as the expected outcomes.