Head and neck cancers originate in areas like the mouth, throat, voice box, sinuses, and salivary glands. These cancers often arise from squamous cells lining moist surfaces. Radiation therapy is a primary treatment, aiming to destroy cancer cells and shrink tumors. It can be used alone or with surgery or chemotherapy.
Types of Head and Neck Radiation Therapy
External Beam Radiation Therapy (EBRT) is a common treatment for head and neck cancers, delivering radiation from a machine outside the body. This method uses high-energy rays, like photons, to target the tumor while minimizing exposure to healthy tissues. The patient lies on a treatment table as the machine rotates, precisely directing the beams.
Intensity-Modulated Radiation Therapy (IMRT) is a sophisticated EBRT type, widely used for head and neck cancers due to the region’s complex anatomy. IMRT uses computer-controlled linear accelerators to deliver radiation beams of varying intensity to different tumor parts. This allows for a highly conformal dose, shaping the radiation to the tumor’s exact contours and reducing exposure to sensitive structures like salivary glands and the spinal cord.
Proton therapy is an advanced external beam radiation that uses protons instead of photons. Protons deposit most energy at a specific, controllable depth, known as the Bragg peak, before rapidly falling to zero. This allows for precise dose delivery to the tumor, with minimal radiation exiting beyond the target. This can be beneficial for tumors near delicate structures, potentially reducing side effects compared to traditional photon therapies.
Brachytherapy involves placing radioactive sources directly into or very close to the tumor. For certain head and neck cancers, like some oral cavity or lip cancers, brachytherapy may be used. The material can be temporarily or permanently implanted, delivering a high radiation dose to a localized area while sparing surrounding healthy tissues more effectively than external beam methods.
The Radiation Therapy Process
Radiation therapy begins with a consultation with a radiation oncologist and a multidisciplinary care team. The team evaluates the cancer type, stage, and patient health to develop a personalized treatment plan. This assessment ensures the chosen approach aligns with the patient’s needs and medical history.
Following consultation, patients undergo a simulation process for precise treatment planning. This involves imaging studies like CT, MRI, or PET scans to accurately map the tumor’s location and its relationship to surrounding organs. During simulation, custom immobilization devices, often a thermoplastic mask, are created to ensure consistent patient positioning for every treatment session.
Treatment delivery involves daily sessions, five days a week, for several weeks, typically five to seven weeks. Each daily session is brief, lasting 15 to 30 minutes, with radiation delivery taking only a few minutes. Patients lie in the exact position determined during simulation, and the linear accelerator delivers the prescribed radiation dose.
Throughout treatment, patients receive regular monitoring from their healthcare team, including weekly check-ups with the radiation oncologist. These appointments allow the team to assess treatment effectiveness, manage emerging side effects, and make necessary adjustments to the care plan. This oversight helps ensure patient comfort and optimize treatment outcomes.
Managing Side Effects of Radiation Therapy
Patients undergoing head and neck radiation therapy experience short-term side effects due to the radiation’s impact on healthy tissues. Mucositis is a frequent issue, characterized by painful mouth and throat sores that can make eating and swallowing challenging. Management involves pain medication, topical rinses, and sometimes a temporary feeding tube to ensure adequate nutrition and hydration.
Dry mouth (xerostomia) occurs when salivary glands are damaged, reducing saliva production. This can affect taste, speech, and increase dental problems. Patients use saliva substitutes, drink small sips of water frequently, and practice meticulous oral hygiene to alleviate discomfort. Difficulty swallowing (dysphagia) can result from inflammation and scarring in the throat muscles.
Skin changes within the treated area are common, ranging from redness and irritation to peeling, similar to a severe sunburn. Gentle skin care, including mild soaps and non-irritating moisturizers, is advised to soothe the skin and prevent infection. Patients may also experience fatigue, requiring adequate rest and careful pacing of activities.
Taste changes are reported, with food tasting bland, metallic, or different. Maintaining nutritional intake is important, and dietary counseling can help find palatable options. Nausea, though less common than with chemotherapy, can occur, especially if the upper digestive tract is in the treatment field. Anti-nausea medications can provide relief.
Open communication with the healthcare team is important for effective side effect management. Patients are encouraged to report new or worsening symptoms promptly, allowing the team to intervene with appropriate medical interventions, nutritional support, or referrals to specialists like speech therapists or dietitians. Proactive management can improve comfort and treatment adherence.
Life After Radiation Therapy
After radiation therapy for head and neck cancer, a follow-up care plan is established to monitor recovery and detect potential recurrence. Regular post-treatment appointments, including physical examinations, imaging scans like CT or MRI, and endoscopic evaluations, are scheduled for several years. These assessments help track healing, assess long-term effects, and identify new concerns.
While many acute side effects resolve within weeks to months, some individuals may experience persistent long-term effects. Persistent dry mouth (xerostomia) and swallowing difficulties (dysphagia) are common, requiring continued management strategies like saliva stimulants or speech therapy. Neck stiffness and fibrosis in the treated area can also occur, benefiting from physical therapy to maintain range of motion.
Dental issues are a long-term concern due to reduced saliva and potential direct radiation effects on jawbone. Regular dental check-ups, fluoride treatments, and meticulous oral hygiene are important preventative measures. Specialized dental care or hyperbaric oxygen therapy may be recommended to address severe dental or jawbone complications.
Rehabilitation improves quality of life after radiation therapy. Speech therapists assist with swallowing exercises and voice rehabilitation, while physical therapists help manage neck stiffness and improve range of motion. Nutritional counseling provides guidance on maintaining adequate caloric intake and addressing ongoing taste or swallowing challenges.
Emotional support is important for recovery, as navigating life after cancer treatment can be psychologically challenging. Patients may benefit from counseling, support groups, or connecting with other survivors. This holistic approach addresses both physical and emotional aspects of recovery, promoting overall well-being.