Radiotherapy is treatment through radiation. High energy beams of radiation are directed at the cancerous tumour, hopefully 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.
If your cancer is in the head or neck, it is extremely likely that part of the treatment will 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 are side-effects to consider, detailed on this page.
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 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 your treatment begins, you will usually have a CT or MRI scan of the affected area, which will allow your medical team 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. By using these detailed scans, 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 is to keep the body still during treatment and protect the parts of the body which are not being targeted. The mask is created in a mould room and is a similar process to paper mache: a mould is made from plaster to fit the patient and then is taken off to dry. Then, a see-through plastic mask is made to fit the patient’s face exactly.
Having a mask fitted can be a slightly disconcerting experience for some people, but does not take long. Talk to your radiotherapist, nurse, mould technician or doctor if you are worried about feeling claustrophobic and help may be available.
Once your mask is made and your medical team are secure in their calculations, treatment can begin.
Radiotherapy 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 would normally be the maximum period of treatment, but will be specified by your medical team.
Treatment occurs in the radiotherapy room, which can be a little daunting for some patients at first. To ensure accuracy, the mask is placed over the head and strapped to the treatment table. Tell your team before treatment begins if concerned about claustrophobia, but many patients say they got used to the treatment routing very quickly and that nervousness stopped.
Once you are secure and 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.
The radiotherapy machine is turned on and the high energy radiation is directed at the tumour. The length of time depends on what kind of radiotherapy is being adminstered. There are a few different kinds of this treatment used to treat head and neck 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 us to confirm the position of the patient and the tumour and 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 cancer types.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)
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 are 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. The angle of the beam, the dose rate and the leaf speed are all independently controlled, making this a very accurate form of treatment. Arc therapy treatments also take much less time to deliver than other radiotherapy techniques.
WHICH TREATMENT IS BEST?
Each patient will be different and the MDT will discuss what treatment is most suitable for each individual case. The choice of what type of radiotherapy will also vary from hospital to hospital. 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, you can find that information here.
Naturally, the best treatment is the most effective treatment and also the treatment that has the least damaging side effects. We have gone over some of the side effects of radiotherapy on this site. Some are temporary but some kinds of treatment can have long term effects on the voice, on saliva production and swallowing. The more advanced and accurate radiotherapeutic treatments like IMRT and VMRT do far less damage to the healthy tissue than older, less precise treatment.
We advocate all patients receiving the most advanced and appropriate treatment for their conditions. 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 deserve.
As with chemotherapy, there are unfortunately numerous side-effects patients may have to endure when undergoing radiotherapy treatment. These can be very challenging for the patient and their carers, but every patient is different, and while some may have to endure a period of discomfort and difficulty, others may not suffer as much.
Treatment for cancer can, honestly, be wholly unpleasant and take a while. However, if you are prepared for potential side-effects and know the best ways to live with them, you can keep the energy and attitude that you will need to fend off your illness.
Unlike many chemotherapy side-effects, those of radiotherapy may last beyond the period of treatment. It is important to understand all outcomes, and to discuss your treatment with your medical team to ensure the course of action is the best for both treating the illness AND for your long-term happiness. Regardless, your medical team will do what they can to alleviate any pain and discomfort caused.
Because of the radiation passing through your body, the skin around the treated area can often become red and sore, a lot like a bad sunburn. Fair-skinned people tend to find this effect worse than those who are darker-skinned, but it changes from patient to patient. It can be particularly uncomfortable during subsequent treatments as the mask may rub against your skin. Burns should start to subside after treatment stops.
WHAT YOU CAN DO: Your medical team can provide you with creams to help. These will vary, but generally will work to replace the moisture that has been lost in the skin.
It is advisable to wear natural fibres and avoid tight collars during treatment to minimise discomfort from your clothing.
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 drastic weight loss may effect 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 or peg to ensure you are getting all the nutrition you need.
The most common side-effect from any cancer treatment is tiredness. This can be made worse is radiotherapy is combined with other treatment like 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. Patients should not overextend themselves, and should rest and nap when needed. Carers should be able to handle chores and other tasks. Listening to the body and resting when required is important during and after treatment.
If radiotherapy beams are targeted at an area with hair on it, it is likely that hair loss will occur. This can be where the beams enter the body or where they leave the body. Due to the precise nature of radiotherapy, your radiographer should be able to tell you exactly where hair will be lost. The effects are not usually permanent, but may be. If only temporary, hair may grow back a different colour or texture to how it was before radiotherapy.
WHAT YOU CAN DO: Because hair loss can be quite an upsetting side-effect for patients, many opt to use wigs to help with the appearance of normality and to keep their spirits high. If this is something you choose to do, you may be able to obtain an extremely life-like wig either for free or at a discount. However, due to the nature of radiotherapy, areas affected by hair loss may be quite small.
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, 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. We use over 70 muscles when we talk. All of these things can become very difficult during and after treatment, but the effects can last a lot longer than other side-effects, and may require dedicated care to recover from.
WHAT YOU CAN DO: To aid recovery there are some specialist speech therapists who will create a programme of exercises to strengthen the muscles in the neck and restore their function. Patients and their loved ones should be prepared for the road to normality to be long and difficult, but many will find it worth it to regain the full use of their neck.
DAMAGE TO THE SALIVA GLANDS
Much in the same way as the neck muscles, 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). In the aftermath of treatment, many patients experience dry mouth which can be a long term problem. Dry mouth is uncomfortable, but can also cause trouble eating and talking.
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 the saliva glands are damaged, artificial saliva products may be used to keep the mouth moist and to aid with eating and talking.
There is a lot of support available to ensure that patients get the right follow-up treatment to deal with any side effects and long term issues. Check out our section devoted to follow-up care for more information.