Radiation therapy uses high-energy x-rays to destroy cancer cells. Radiation therapy destroys only the cancer cells in the area of the body where the radiation is aimed. If cancer cells are located outside the radiation field, those cancer cells will not be affected by the radiation. Radiation therapy can be used as the only treatment for head and neck cancer, but is often used in combination with surgery and/or chemotherapy.
The first visit to a radiation oncology office is for a meeting with the radiation oncologist, a physician who will listen to the history of your problem and perform a physical examination. If radiation treatment is recommended, a date will be chosen for treatment planning for radiation therapy. This is called a ‘simulation’, where x-rays or a CT scan are used to plan the type and direction of radiation beams used to treat the cancer. Because head and neck cancers are located very close to important structures such as brain, brainstem, spinal cord, eyes, and critical cranial nerves, radiation therapy must be delivered very accurately. Many patients with head and neck cancers are treated using face masks which securely and comfortably hold the head very precisely still for daily radiation treatment. These face masks are created at the time of simulation. Simulation is followed by several days of calculations and safety checks in the radiation department, which finalize the treatment plan. The treatment course will start a few days after the initial treatment-planning session.
Radiation treatments are most commonly given once a day, five days a week for five-to-seven weeks, depending on the treatment schedule selected by your radiation oncologist. Generally, for the first couple of days of treatment planning and treatment start, your visit to the radiation oncology department may take an hour or two. After that, each individual treatment takes a shorter amount of time, which varies depending on the complexity of the set-up. Radiation treatments involve the use of beams of x-rays. So, similar to receiving a chest x-ray, patients do not feel or see anything during a radiation treatment although the machine can makes a sound or buzzing noise at times.
Radiation therapy can have side effects. The side effects of radiation therapy are not the same for all patients, and depend on the specific area of the head and neck that is being treated. Generally, side effects of radiation therapy develop about two weeks into the course of treatment. Common side effects for head and neck cancer patients include sore throat, loss of taste, dry mouth, hoarseness, and skin reaction (‘sunburn’). Sore throat (also known as ‘mucositis’) is the main side effect that can make head and neck radiation therapy difficult. However, there are many options for managing the side effects of head and neck radiation therapy, including mouth rinses, topical analgesics, over-the-counter pain relievers, skin lotions, opiate pain medications, or even temporary feeding tubes if needed. The radiation oncologist and radiation nurse help to care for patients when they have side effects during a course of radiation treatments. When side effects occur, it is sometimes tempting to take a break from treatments. But a break from treatment allows cancer cells to recover, can reduce the chance of cure, and is usually not advised.
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Patients are an important part of the radiation oncology team. It is important to arrive on time for all radiation therapy appointments. Patients should feel comfortable asking questions and telling the doctor or nurse about side effects or concerns. It is certainly important to inform the team when a patient is experiencing pain, as pain can typically be controlled easily. Following the advice of the doctor, nurse, or dietician about how to consume enough calories to maintain weight is also critical during radiation therapy for head and neck cancer. And stopping smoking is one of the most important things a patient can do to help themselves during and after radiation treatment.
Once radiation therapy for head and neck cancer is completed, patients typically return to see the radiation oncologist for follow up visits as needed. Various members of the cancer team (surgeon, medical oncologist, radiation oncologist, dentist/oral surgeon, others) will see patients over time to insure that the cancer is controlled and the patient is not having side effects from treatment. This followup can continue for months or years after head and neck cancer treatment.