Radiotherapy for head and neck cancer

Radiotherapy is the use of high-energy x-rays to destroy cancer cells. It is an important treatment for head and neck cancer.

Radiotherapy may be used on its own but is often given in combination with chemotherapy. This is called chemoradiation.

Chemoradiation is often the main treatment for head and neck cancer. The chemotherapy helps the radiotherapy to work better.

It may be used:

• as your main treatment, if the cancer is locally advanced
• for cancers that cannot be removed with surgery
• when surgery could have serious effects on your speech or swallowing
• after surgery, to reduce the risk of the cancer coming back (adjuvant treatment)
• to treat cancers in harder-to-reach areas, such as the nasopharynx or throat (oropharynx).

Chemoradiation can cause severe side effects so it may not be suitable for everyone. If you are not well enough to cope with the side effects of chemoradiation, you may be given radiotherapy on its own.

If a cancer is bigger, or is affecting other tissues nearby (locally advanced cancer), radiotherapy is usually combined with other treatments. It may be given:

• after surgery (with or without chemotherapy) to destroy any remaining cancer cells and reduce the risk of cancer coming back
• in combination with chemotherapy (chemoradiation), without surgery
• in combination with the targeted therapy drug cetuximab
• to reduce symptoms (palliative radiotherapy).

Radiotherapy is usually given from outside the body as external-beam radiotherapy. A beam of x-rays is directed at the cancer from a large machine called a linear accelerator.

External-beam radiotherapy is given in the hospital radiotherapy department. It can be used in different ways. It may be given:

• Monday to Friday, with a rest at the weekend – this is the most common method
• more than once a day
• every day, including at the weekend.

Treatment may take 4 to 7 weeks, depending on the type and size of the cancer. If you are having palliative radiotherapy, you may have a single treatment or 1 to 3 weeks of treatment.

Your cancer doctor (clinical oncologist), specialist nurse, or radiographer will discuss the treatment with you. They are part of your radiotherapy team.

IMRT is the most common type of external-beam radiotherapy used for head and neck cancer. It uses multiple beams of radiation that come from different directions, and shapes the beams to match the shape of the cancer. Shaping the beams lets the doctors give higher doses of treatment to the cancer and lower doses to the surrounding healthy tissue.

Research has found that, for some people, having IMRT rather than standard radiotherapy may reduce some long-term side effects, such as a dry mouth. This is because the radiotherapy shapes the beams to avoid the salivary glands, which is where saliva (spit) is produced.

The treatment machines can also take pictures and scans. Some people may have frequent scans during their treatment. This is to make sure the treatment accurately targets the treatment area. Changes can be made if needed, for example if you lose weight during treatment.

Many types of external beam radiotherapy are conformal. This means the beams are specially shaped to fit the treatment area. Conformal radiotherapy can be used to treat many different types of cancer.

Proton beam therapy uses proton radiation rather than x-rays to destroy cancer cells. Proton beams can be made to stop when they reach the area being treated. This is different to standard radiotherapy beams, which pass through the area and some healthy tissue around it. Proton beam radiotherapy is not widely available in the UK and is only suitable for a small number of people.

Before each treatment session, the radiographer will position you on the treatment couch and carefully fit your mask. They will leave the room before the treatment starts. The treatment only takes a few minutes. There is a camera in the room, so the radiographer can see you from the next room. They can also hear you through an intercom. If you need help, you can raise your hand and the radiographers will return to the room.

External radiotherapy does not make you radioactive. It is safe for you to be with other people, including children and pregnant people, throughout your treatment.

Radiotherapy to the head and neck causes side effects. Your radiotherapy team will tell you what to expect. They will explain how side effects can be controlled and what you can do to help to manage them.

We have more information about side effects of radiotherapy for head and neck cancer.

Macmillan is also here to support you. If you would like to talk, you can:

• Call the Macmillan Support Line on 0808 808 00 00.
• Chat to our specialists online.
• Visit our head and neck cancer forum to talk with people who have been affected by head and neck cancer, share your experience, and ask an expert your questions.