Radiotherapy

Radiotherapy is treatment through radiation. High energy beams of radiation are directed at the cancerous tumour with the aim of destroying it. We have used radiation for over 100 years in medicine – most commonly as X-rays – but we can now use it to treat and cure illnesses or to relieve symptoms.

Part of your treatment may involve radiotherapy. There are several stages to this treatment, and quite a few staff involved in administering it. As with chemotherapy, radiotherapy damages healthy cells as well as cancerous ones so there some side effects to consider.

The location of the tumour and its stage will help your medical team decide which course of treatment is the most appropriate. It is likely in these kinds of cancers that there will be some chemotherapy administered prior to radiotherapy, weakening the cells before the radiation is used to kill them.

If you have any questions or concerns about your treatment, check out our FAQ page and be sure to ask any and all questions to your doctors before, during and after treatment.

BEFORE RADIOTHERAPY

Before your treatment begins, your medical team will arrange an imaging scan of the affected area which will allow them to see exactly where the tumour is. They will then calculate how much radiation to use in order to treat it. Radiation is quite harmful, so your doctors, radiographers and physicists will ensure that they are not using too much at any time. Having these detailed imaging scans means that the team will be able to target the radiation very precisely, lessening the impact on healthy tissue.

In preparation for radiotherapy, patients need to have a mask fitted. This helps to keep your body still during treatment and protect the parts which are not being targeted. 

Having a mask fitted can be a slightly disconcerting experience for some people, but does not take long. Talk to your medical if you are at all worried and they will talk you through the process and let you know of any help that may be available.

YOUR TREATMENT

Once your Radiotherapy treatment starts it is most effective when administered with as few breaks as possible, allowing the cancer cells no time to recover. Ideally, treatment will continue every day from Monday to Friday for as long as necessary – stopping only for extenuating circumstances. The length of treatment will depend on size, location and aggressiveness of the tumour, but also on the patient’s health. Seven weeks is generally the maximum length of treatment, but this can vary depending on your individual circumstances.

To ensure accuracy, the mask is placed over your head and secured to the treatment table. If you are concerned that you may feel claustrophobic, then it is worth discussing this with your medical team.

Once you are as comfortable as possible, treatment will start. This requires everyone but you to leave the room, but you will be able to contact the radiographer through cameras and an intercom at any time.

The radiotherapy machine is turned on and high energy radiation is directed at the tumour. The length of time depends on what kind of radiotherapy is being administered. There are a few different types of this treatment that are used to treat throat cancers:

TYPES OF RADIOTHERAPY

Image-guided radiotherapy (IGRT)

IGRT is the use of a variety of imaging techniques, such as X-rays or CT scans, alongside radiotherapy. Imaging allows your medical team to confirm the position of your tumour, so they can target the radiotherapy beam more precisely. 

Intensity-modulated radiotherapy (IMRT)

IMRT uses linear accelerators to deliver very precise doses of radiation which are shaped to the size of the tumour. It is a routine radiotherapy treatment for some types of cancer. Not every hospital has the equipment available to deliver IMRT or other advanced forms of radiotherapy. Ask your doctor about your radiotherapy treatment. 

Volumetric modulated arc therapy (VMAT)Image courtesy of Varian Medical Systems, Inc.  All rights reserved.

VMAT is a new radiotherapy method first performed in the UK at The Royal Marsden in London. This kind of radiotherapy is also called RapidArc –  names are specific to the equipment manufacturers, but use the same technique.

Using three-dimensional volume imaging, treatment can be designed and delivered to maximise the radiation dose the tumour receives and minimise exposure of the surrounding healthy tissue. This method has advanced independent controls for the medical team, making it a very accurate form of treatment. VMAT therapy treatments also take much less time to deliver than other radiotherapy techniques.

WHICH TREATMENT IS BEST?

Everyone is different, and your medical team will let you know which treatment will be most suitable for you. The types of radiotherapy available will vary from hospital to hospital and some hospitals will not be able to offer all types of radiotherapy or surgery.

As a patient on the NHS you have the right to choose where you would like to be treated. We have compiled key facts about the NHS constitution and the rights of a patient and you can find that information here.

We advocate that all patients receive the most advanced and appropriate treatment for their condition. No patient deserves anything less than the best treatment available. We have outlined what we believe to be the 'Gold Standard of Care' - this is what we have been advised as the highest standard of care available and what patients going through treatment should be offered.

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POTENTIAL SIDE-EFFECTS

Due to the nature of radiotherapy there are side effects that you may experience.

MUCOSITIS

Some patients can find themselves with this condition, which can cause the linings of the mouth or throat to become inflamed and ulcerated. It is a side effect of both radiotherapy and chemotherapy. It is unpleasant, but should start to subside after treatment stops.

WHAT YOU CAN DO: It is important to eat as much as possible when undergoing treatment in order to keep your energy up, and weight loss may affect where the radiotherapy beams have been targeted. However, Mucositis can make eating and drinking very uncomfortable. Your medical team will be able to offer as much support as possible and may be able to advise ways in which to lessen the discomfort. If it is compromising your ability to eat, your medical team may recommend a feeding tube to ensure you are getting all the nutrition you need.

TIREDNESS

The most common side effect from any cancer treatment is tiredness. This can be more severe if radiotherapy is combined with another treatment, such as chemotherapy. Tiredness can last for several months after treatment ends while the body uses increased amounts of energy to recover.

WHAT YOU CAN DO: The best cure for tiredness is rest. You should not overextend yourself and should rest and nap when needed. Listening to your body and resting when required is important during and after treatment.

HAIR LOSS

If radiotherapy beams are targeted at an area with hair on it, then hair loss may occur where the beams enter or leave the body. Due to the precise nature of radiotherapy, your radiographer should be able to tell you exactly where hair may be lost. The effects are not usually permanent, but can be. If only temporary, hair may grow back a different colour or texture to how it was before radiotherapy.

WHAT YOU CAN DO: It is likely that your hair will grow back. 

TISSUE DAMAGE

Potentially the most challenging side-effect faced by radiotherapy patients is the tissue damage caused around the treated area. Radiation works by destroying the malignant cancer cells but can also damage the surrounding healthy tissue. While the healthy tissue will normally recover, the damage can cause pain and discomfort – and, around the head and neck, can sometimes stop certain things from working properly.

There are many muscles in the neck which are used for everything from turning your head to eating and drinking. Some or all of these things may become difficult during and after treatment and may require dedicated care to recover from.

WHAT YOU CAN DO: A speech and language therapist can assist by providing a programme of exercises to strengthen the muscles in the neck and to aid swallowing.

DAMAGE TO THE SALIVA GLANDS

Saliva glands can be damaged by radiotherapy beams during treatment. The amount of damage will depend on the type of radiation therapy and how close the tumour is to the saliva glands (if it’s not the saliva glands themselves that are cancerous). After your treatment you may experience dry mouth, which can be a long term issue. 

WHAT YOU CAN DO: Discuss your options in detail with your medical team, as some forms of radiotherapy are more precise and therefore less damaging than others.

If your saliva glands are damaged, artificial saliva products can be used to keep the mouth moist and to aid with eating and talking.

 

There is a lot of support available to ensure that you get the right follow-up treatment to deal with any side effects and long term issues you may experience. Check out our section devoted to follow-up care for more information. 

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