Royal Prince Alfred Hospital Royal Prince Alfred Hospital
Radiation Oncology

Radiotherapy for Head and Neck Cancer

‘Head and neck cancers occur inside the sinuses, nose, mouth, salivary glands and down through the throat. Although they arise in these different areas, these cancers are treated in similar ways and so are considered as a group.’ (Cancer Council Website)
 
The treatment of head and neck cancers can include surgery, radiotherapy or chemotherapy, either alone or in combination. Radiotherapy, like surgery is a localised treatment to the head and neck area whereas chemotherapy is a systemic (whole body) treatment and is often used with radiotherapy to make the cancer more sensitive to radiotherapy. This is known as radiosensitisation.
 
The treatment course received by a patient depends on a variety of factors; including the type of tumour (histology), location, stage of the disease, your general health and age.
 
Your Radiation Oncologist will advise you what regime is most suitable for you, how effective the therapy will be and how the treatment will affect you.
 
 
What should you bring to your Radiotherapy Planning appointment?
 
  • A referral letter from your doctor (if not already submitted)
  • Medicare care card
  • All private scans relating to your current diagnosis 
  • A list of your current medications (including any medication allergies) 
 
What happens during Planning?
 
 
When you come into the Radiation Oncology Department, please report to the reception area. You will be guided to the waiting room where you will be met by your Radiation Therapists. The Radiation Therapists will introduce themselves and ask you to confirm your identity by asking you to state:
  • your full name,
  • date of birth, and
  • the body site you will be having treatment to.
You will find that this identification process is repeated multiple times during your treatment. This is because correct identification of patients is crucial to ensure that the correct treatment is given to the correct patient.
 
After correct identification, your Radiation Therapist will briefly explain the planning procedure and give you the opportunity to ask questions. You will then be shown to the change rooms to change into a gown. You will then be escorted to the Radiotherapy Simulation and Planning area where your Radiation Therapists will position you on the CT scanner bed.

Typically, you will be lying on your back with the aid of a neck rest and knee support. You will be asked to hold on to some hand straps as well.

Your Radiation Therapists will also ensure that you are lying as straight as possible on the CT scanner bed. They will do this using the lasers situated in the CT scanner room. This process will also be repeated at each of Radiotherapy sessions. 

You will then have a customised mask made for you. Making the mask is a painless 5-10 minute process. You will wear your mask during your planning CT scan and then everyday during treatment. The mask helps reduce any movement of your head during treatment so that the planned treatment course can be delivered accurately and precisely.

Please see below for the mask making process.

   

maskmaking_
The mask making process
 
 
You will then undergo a CT scan in the treatment position. It is very important that you breathe normally and lie very still during the CT scan as any movement can affect the quality of the scans and you may then need to have the scans repeated.
  
 
Patient with the mask in place for the CT scan
 
  
Once the scan is complete, your Radiation Therapists will take photos of the area to be treated and your face for identification purposes. These will be attached to your treatment plan and medical records. 
 
Your Radiation Oncologist will be present during the planning session which takes approximately 30-45 minutes.
 
At the end of the Radiotherapy Planning session you will be given an appointment card which will contain details of your first treatment (date and time).
 
Your Radiation Therapist will then escort you back to the change rooms. When you have collected all of your belongings, your Radiation Therapist will show you the location of the treatment waiting room. This is where you will wait for your treatment every day once Radiotherapy starts.
 
You will also be shown how to scan your card at the front desk barcode scanner which you will use every day when you arrive for treatment. This is how you will notify the treatment staff of your arrival in the Department.
 
 
What happens during Treatment?
 
 
When you come in for your first treatment, you will need to scan your card at the front desk and take a seat in the waiting room.
 
One of your Radiation Therapists will call your name when they are ready to treat you.
 
Your Radiation Therapist will introduce themselves and ask you to confirm your identity by asking you to state:
  • your full name,
  • date of birth, and
  • the body site you will be having treatment to.
Your Radiation Therapist will then sit down with you to discuss the treatment process, and expected side effects relating to your treatment. You will have already discussed side effects with your Radiation Oncologist but if you have any questions please feel free to ask your Radiation Therapist who will answer your questions to the best of their knowledge. If necessary they will refer you to the appropriate member of your treatment team who can provide you with further information. 
 
 
 
 
Your Radiation Therapist will take you to your treatment room and you will be asked to lie on the treatment bed in the same position as you were in your planning session.
 
Your mask will then be placed and secured.
 
Your Radiation Therapists will then dim the lights so that the laser beams in the room can be seen clearly. These will be used to guide the them in setting you up in the exact same position every day.
 
Patient receiving Radiotherapy
Your Radiation Therapists may feel for your bones and move you slightly when they are setting you up. It is important that you do not try to help unless asked as usually only millimetre adjustments will be made.
 
The bed and machine will then be moved into the treatment position. The machine may come close to you, but will not touch you at any point during the treatment process.
 
When Your Radiation Therapists are ready to treat you, they will let you know and then leave the room. You will hear a doorbell sound as they leave.
 
Just stay nice and still and breathe normally.
 
There are cameras and a microphone inside the room and your Radiation Therapists will use these to monitor you throughout the treatment. If you need your Radiation Therapists for any reason, wave your hand or call out and your Radiation Therapists will come straight in.
 
When the treatment is over, your Radiation Therapist will come back into the room and assist you off the bed.
 
Although the actual treatment only takes a few minutes, the whole treatment session (from positioning to finishing treatment) may take about 10-20 minutes each day.
 
During the course of Radiotherapy, you will see your Radiation Oncologist or another doctor on your treatment team once a week on a set review day. This is important as it allows them to monitor your progress and address any concerns you may have about your treatment. Please allow for more time on this review day as your visit to the hospital will be slightly longer.
 
 
 
 
Due to individual treatment regimes and medical circumstances, side effects will vary from person to person and are specific to your customised plan.
 
Radiation Oncology Nurse looking atfer a patient's skin care
Your Radiation Oncology medical team will see you once a week during your treatment to monitor your progress and to help manage any side effects.
 
If you have any problems between these visits please speak to your Radiation Therapist who will contact your doctor for you as needed.
 
Some of the possible side effects are listed in the table below. Most side effects usually occur one to two weeks into treatment or may appear during the course of your treatment.
 
Many of these side effects can be managed and will gradually disappear after your treatment has finished.
 
Please let your treating team know if you develop any of these symptoms so they can be managed and you are more comfortable.
 
You will also be seen by the Dietician and Speech Pathologist regulalry during your treatment to ensure that you are receiving adequate nutrition and  have support with managing any swallowing difficuties.   
 
 
 
     Side effects
     What can help?
 
     Fatigue (tiredness)
 
     Most patients experience reduced energy levels, tiredness and      lack of motivation soon after starting treatment. Just listen to      your body and rest if needed.  
 
     Dry, red, itchy skin (in      the treatment area)
 
     Skin reactions tend to appear after about two weeks of      treatment and may develop even further to become itchy and      tender as the treatment continues.
 
     The skin reaction is similar to that of sunburn; it may become      pink, and may feel warm to touch with mild discomfort.
  • Avoid sun exposure – cover up and wear a hat if in the sun
  • Use a mild or moisturising soap in the treatment area
  • Avoid irritant products containing alcohol, perfumes or additives and products containing Alpha Hydroxy Acids (AHA) as this can increase skin irritation. If you are unsure of whether or not to use a product, feel free to ask the nurses or doctor.
  • Bathe using lukewarm water, and avoid scrubbing in the treatment area.
  • It is not recommended to wet shave in the treatment area, but an electric razor can be used.
  • Apply simple body lotions or creams on affected area at least once daily. 10% Gylcerin Sorbolene moisturiser is recommended.
  • Your doctor may prescribe creams/ ointments to help relieve severe itchiness
  • If the skin peels, then dressings may be helpful. Your doctor or nursing team will organise this for you.
     Sore throat and mouth      depending on area      being treated
 
  • Avoid dry, spicy and acidic foods
  • Avoid alcohol and caffeine; keep high water intake
  • Avoid hot meals
  • Eat soft or pureed foods, as required
  • Regular mouth care with sodium bicarbonate solution before and after meals
  • Your doctors will prescribe medications as needed to help you manage the pain. Usually they would recommend starting with 2 dissolving paracetamol (Panadol) tablets taken 4 times a day regularly. Taking the pain killer medication regularly through the day is better than waiting until the pain becomes severe.
     Difficulty swallowing
  • You will be referred to a speech pathologist who will provide you with an exercise routine to help with your swallowing and make some modification with your diet. For more information about the role of the speech pathologist, click here.
  • Managing your pain effectively will also help the swallowing difficulties.
     Dry Mouth and thick      mucus (phlegm) instead      of saliva
 
  • You will be recommended regular mouth washes (either with warm salt water or with sodium bicarbonate) to maintain your oral hygiene and for your comfort.
  • Avoid mouth washes with alcohol to avoid further irritation and dryness.
  • Taking frequent sips of water (carry a bottle of water with you) can provide temporary relief. 
     Loss of appetite,      altered sense of taste
 
     You may not feel like eating your normal meals because of the      altered taste. However, it is important that you continue to      maintain your nutrition.
 
     Some suggestions are to:
  • Consume foods that taste good to you
  • Add more flavour to food if food tastes is dull or metallic
  • Eat small meals and snacks as tolerated
     Weight Loss (if      adequate nutrition is      not maintained)
 
     People often lose interest in their food during radiotherapy due      to soreness of the mouth /throat and the change in taste.
 
     This can lead to weight loss in some cases.
 
     Good nutrition and avoiding weight loss is very important to      make sure that you complete your planned treatment and      maximise your chance of cancer control. Good nutrition      also helps you recover well from treatment.
  • Your doctors and dietician will monitor your weight throughout your treatment and recommend ways to improve your nutrition.
  • You are advised to eat small amounts of food as often as can be tolerated.
  • Your Dietician will advise you on nutritional supplements that can be added to your diet when this becomes necessary.
  • You may be recommended to have a feeding tube (also called a PEG tube) placed directly into your stomach even before treatment starts for the purpose of maintaining your nutrition throughout your treatment and recovery periods. When taking in enough nutrition through the mouth becomes difficult, your doctors and dietician will advise you on how to start feeds through the feeding tube.
     Hair loss (in the      treatment area)
 
     Hair loss normally occurs after about two weeks of treatment.      Usually temporary but may be permanent.
 
 
 
  
Late Side effects of Radiotherapy to the head and neck area
 
 
There are some uncommon or rare side effects that may occur months or years after treatment. These are called late effects and may include the following depending on the part of the head and neck area receiving treatment:
 
 
     Side effects
     What can help?  
 
     Persistent dryness of      the mouth      (xerostomia) and      difficulty with eating      certain types of foods      (eg spicy foods).
 
  • Avoid foods that irritate your mouth and throat
  • Artificial saliva or medication to stimulate saliva production may be prescribed by your doctor if required
 
     Dental concerns
     Having a dry mouth may also predispose you to tooth decay      and dental infections.
 
     Dental referrals are usually made for all head and neck patients      before the start of their treatment as well as later on during and      after the treatment course to carry out preventative dental      treatments. 
 
     Poor healing after dental procedures in the future (it is      important that you inform your dentist about your previous      radiotherapy prior to dental extractions)
 
     Underactive thyroid      gland
 
     This can be managed with thyroid hormone tablets.
 
     Fibrosis or scarring      of the soft tissues of      the neck in the area      treated.
 

     This may result in firmness and stiffness of the neck in the area      treated.

 
 
Chemotherapy related side effects
 
 
If you receive concurrent chemotherapy during your radiotherapy for the purpose of enhancing the effects of radiotherapy, you may experience some nausea (feeling sick) and vomiting related to this.
 
Your chemotherapy doctors and nurses will advise you on what you can do to manage this and prescribe you any medications as necessary.
 
Here are some things you can try if you experience nausea or vomiting:
  • Maintain your fluid intake and nutrition
  • Try to eat small amounts of food as often as can be tolerated
  • Avoid greasy fatty foods
  • Avoid foods with strong odours
  • Take the anti-nausea medications prescribed by your team
  • It is often better to take the prescribed medications regularly rather than wait until the symptoms become severe.
 
 
[Any further concerns speak to your doctor or nursing staff in the department]
 
 
 
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