Radiation therapy for head and neck cancers

External beam radiation therapy

Having radiation therapy 

Radiation therapy is carefully planned to make sure enough radiation reaches the cancer, while as little as possible reaches healthy organs and tissues. During treatment sessions, you will lie on a table under a machine called a linear accelerator, which precisely delivers the radiation. The treatment is painless and is usually given Monday to Friday for 6–7 weeks. You usually won’t need to stay in hospital.

Wearing the mask

You wear the plastic mask for about 10–20 minutes at each session. It helps you keep still and makes sure the radiation is targeted at the same area at each treatment session. You can see and breathe easily, but it may feel strange and confined at first. Tell the radiation therapists if you have claustrophobia or the mask makes you feel uncomfortable – you can talk to someone or may be offered medicine to help you relax.

Side effects of radiation therapy

Radiation therapy side effects vary depending on the area treated, the number of sessions, and whether it is combined with chemotherapy. Side effects often get worse 1–3 weeks after treatment ends and then start to improve. Some side effects may last longer, be ongoing or appear several months or years later. Some may be permanent. It is important to talk to your treatment team if you have any concerns or questions on how the treatment may affect you. The most common short-term and long-term side effects are listed below. For information about managing side effects.

During or immediately after treatment – Short-term side effects can include fatigue, mouth sores, taste changes, nausea, loss of appetite, mouth infection (oral thrush), dry mouth, thick saliva and phlegm, swallowing difficulties, skin redness, burning and pain in the area treated, breathing difficulties and weight loss.

Ongoing – Longer-term or permanent side effects may include dry mouth, thick saliva, difficulties with swallowing and speech, changes in taste, fatigue, muscle stiffness, neck swelling, appetite and weight loss, mouth infection (oral thrush), hoarseness, dental problems such as tooth decay and gum disease, difficulty opening the mouth, and hair loss.

Aspiration – Some people develop a temporary or ongoing problem where fluid or food enters the windpipe (trachea) while swallowing. This is called aspiration and it can cause coughing, lung infections such as pneumonia and, sometimes, difficulty breathing.

Thyroid damage – If the treatment damages the thyroid, it can cause an underactive thyroid (hypothyroidism). This can be managed with thyroid hormone replacement tablets.

Osteoradionecrosis of the jaw – Radiation therapy can damage blood vessels, reducing the blood supply to the area treated. Occasionally, the bone starts to die, leading to pain, infection and fractures. This is known as osteoradionecrosis, or ORN. About 5–7% of people who have radiation therapy to the head and neck develop ORN of the jaw. It can occur months or years later, most commonly after having dental work such as the removal of teeth, when the bone is unable to heal itself. This is why you will usually see a dentist before your cancer treatment, so any dental issues can be treated before there is a risk of ORN.

It is very important to tell your dentist that you have had radiation therapy before beginning any dental work. Treatment for ORN may include antibiotics, other medicines or surgery. To help the bone heal, some people may also have hyperbaric oxygen treatment (breathing in concentrated oxygen in a pressurised chamber).