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Radiation therapy for head and neck cancer

Radiation therapy for head and neck cancer
Chemoradiation therapy for head and neck cancer is a difficult journey for any patient, as we have heard from Julie and Roísín. However, the end result can be extremely positive. Tumours of the head and neck cover a range of different areas. These are typically tumours of the oropharynx, that is the tonsil, the base of tongue, the oral tongue, and the floor of mouth; the nasopharynx; the larynx, which is comprised of the glottis, the supraglottis, and subglottis, or the parotid gland. But there are other, less common areas in the head and neck that can also be treated with radiation therapy. Radiation therapy for head and neck cancer is typically delivered with chemotherapy or biological therapies. This is called concomitant treatment.
These other therapies are used to sensitise tumour cells to the radiation therapy, which helps enhance the treatment effect. Before meeting with the radiation oncologist for head and neck radiation therapy, it is important that you have a full dental examination to ensure that all of your teeth are healthy prior to commencing radiation therapy. Following this, you will have your first meeting with the radiation oncologist where the procedure, its likely outcome, and side effects are discussed. It is important for you to understand this process and remember the answers to the questions asked. Only then can you make a decision to have the treatment or not. This is what we call informed consent.
It is a good idea to bring a family member or friend with you to this appointment, as it can be quite difficult to remember everything that has been said, like Julie mentioned in her own story. Having another person to listen and take notes can be very helpful when trying to recall information later. For head and neck radiation therapy, you will wear a mask for treatment. This mask is used to immobilise or keep your head and neck region as stable as possible. It is important that motion is kept to an absolute minimum during radiation therapy. Following the making of the mask, you will then proceed to computed tomography, or CT scanning.
In some radiation therapy centres, the making of the mask takes place in the scanning room, while in others it is in a separate room. During the CT scan you will wear the mask, and radiation therapists take a scan of the full head and neck region. They place small markers onto the mask which are used as references later for the radiation therapists who will deliver treatment on the linear accelerator. In some cases, you will be given an injection of dye into your arm for this scan. The reason for this is to clearly show the lymph nodes of the head and neck region, which is very helpful in planning treatment.
If you are having this dye or contrast, you will be asked a series of questions before the scan begins by the radiation therapist to ensure that you have no allergies. The CT scanning process takes about 20 to 30 minutes in total. Following the scan, you have now finished your pretreatment preparation. If you have had an injection of contrast, you will be asked to stay in the waiting area for a further period of time, up to about 45 minutes, and then you will be free to leave. It typically takes about two weeks to plan treatment for head and neck cancer, but this does vary from country to country, and also by the patient’s individual circumstances.
So it is always best to check with the radiation oncologist as to when your treatment will start. During these two weeks, the radiation oncologist and radiation therapists will clearly outline the area for treatment on the CT scan, known as the target, as well as a normal tissue that must be avoided, known as organs at risk. A plan will then be prepared for treatment by the dosimetrists, medical physicists, and radiation therapists. This planning phase maps out the optimal position of the linear accelerator to deliver treatment to maximise radiation therapy dose to the target, and to minimise it to organs at risk. This ensures the maximum benefit of treatment while keeping side effects as minimal as possible.
When receiving treatment on the linear accelerator for head and neck cancer, the radiation therapists who deliver your treatment will place the mask made at the treatment preparation phase onto you every day. They will then use the laser alignment system in the treatment room to position you for treatment, and will adhere to the guidance of the treatment plan that was specifically prepared for you. The radiation therapists will frequently take images, x-rays, or scans of your position to ensure that it is absolutely correct.
The length of time that a head and neck patient will attend for radiation therapy varies depending on the protocol that the radiation oncologist has selected for you from evidence-based practise, but as is typically between five and seven weeks, five to six days per week. Some patients may be treated twice per day in some protocols. The protocol selected by the radiation oncologist is the one that clinical trials have proven to best manage the specific type of head and neck tumour in question. During treatment, you will experience side effects. The severity of these side effects does depend on the area to be treated, the protocol that is being followed, and on individual patient reaction.
The side effects that most head and neck cancer patients can expect to experience are skin reddening, called erythema. This typically would start by the end of week two, and can progress to some breakages in the skin. During this period the radiation therapists, radiation oncology nurses, and radiation oncologists will work together to make the skin reaction as manageable as possible. You may also experience difficulties in swallowing, and weight loss during treatment is to be expected. You will be advised by the radiation oncology team together with dietitians on how best to manage this weight loss.
Some patients can continue to eat a soft diet while on treatment, while for others, feeding with a tube in the stomach, known as a PEG tube, may be required in order to maintain weight and fluid levels. You may also experience a dry mouth, which is known as xerostomia. During this period, oral care is extremely important, and you will be advised on how best to manage your oral hygiene while on treatment. Adhering to the care and recommendations of the radiation oncology team during and after treatment is really crucial at this phase.

Both of our patient advocates, Julie and Roisin, had radiation therapy treatment for different forms of head and neck cancer. In this video, we’ve looked at this process and what to expect.

One part of the process, unique to head and neck cancer, is the thermoplastic mask that patients wear during treatment.

Making a mask

As we saw from the video, patients who have radiation therapy for head and neck cancers, will have a mask created for them by a Radiation Therapist.

The mask does not protect you from radiation, rather it is to keep you as still as possible during the treatment.

Radiation therapists are very skilled in creating these masks and understand that some patients may be quite anxious or claustrophobic about having the mask made. Making the mask does not hurt, and feels like a warm cloth being placed over your face. It can feel unusual when it begins to harden however it does not hurt in any way.

Most masks are made from a thermoplastic material that is heated in a water bath or an oven type device. The soft thermoplastic material is gently draped over your face and neck and moulded to the shape of your head.

Each mask is a perfect fit for each individual patient.

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An Introduction to Radiation Oncology: From Diagnosis to Survivorship

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