Radiation therapy for head and neck cancer

External beam radiation therapy is common for treating oral, salivary gland, pharyngeal, laryngeal, nasal and paranasal sinus cancers.

The treatment can be delivered in different ways, including:

• intensity-modulated radiation therapy (IMRT)
• volumetric modulated arc therapy (VMAT)
• TomoTherapy.

These techniques deliver radiation precisely to the affected area, which reduces treatment time and side effects.

Having external beam radiation therapy

Before radiation therapy starts you will be fitted for a plastic mask, called an immobilisation mask. Wearing the mask will help you keep still and ensure the radiation is targeted at the same area during each session. You can see and breathe through the mask, but it may feel strange and claustrophobic at first.

During treatment, you will lie on a table under a machine called a linear accelerator. You will wear the mask for 5–15 minutes during treatment (longer during the planning session).

Treatment itself is painless and is usually given Monday–Friday as outpatient treatment for 6–7 weeks. You will be monitored by the radiation therapist throughout. Let them know if wearing the mask makes you feel uncomfortable.

The side effects vary depending on the area treated, the number of treatments, the type of radiation therapy you have and whether it is combined with chemotherapy.

Side effects often peak in the final week of treatment, or shortly afterwards, then start to ease 2–3 weeks after treatment ends. Some side effects may last longer, be ongoing or appear several months or years later. The most common short-term and long-term side effects are listed below.

• During or immediately after treatment – fatigue, mouth sores, dry mouth and thick saliva, skin redness and burning in the area treated, breathing difficulties, weight loss.
• Ongoing or permanent – dry mouth, thick saliva, difficulties with swallowing and speech, changes in taste, fatigue, muscle weakness, appetite and weight loss, thrush, hoarseness, dental problems, difficulty opening the mouth, hair loss. Some people find that food and fluid goes into the windpipe. This is called aspiration and it causes obstruction and difficulty breathing. People who develop an underactive thyroid (hypothyroidism) may need to take thyroid medication after radiation therapy, see Total laryngectomy.

For information about managing side effects, click here. You can also call Cancer Council 13 11 20 for a free copy of Understanding Radiation Therapy, or download a digital version from this page.

Radiation therapy to the head and neck can damage blood vessels, causing bone in the lower jaw to die and become infected. This is called osteoradionecrosis (ORN).

Having any necessary dental work done before treatment starts reduces the risk of ORN.

Treatment for ORN may include long-term antibiotic medicines or hyperbaric oxygen treatment. While you sit or lie in a pressurised chamber, concentrated oxygen is delivered to the bone to help it heal. Other treatment options include certain medicines and sometimes surgery.

Watch this short video to learn more about radiation therapy.