Radiotherapy for head and neck cancers

Dr Mariza Tunmer informs us about the common side effects experienced by patients undergoing radiotherapy for head and neck cancers.

One of the treatment modalities that may be used to treat head and neck cancers is radiotherapy. 

For patients requiring a long course  of radiotherapy, usually over six to seven weeks, often chemotherapy is combined with radiotherapy.

The chemotherapy may be given once a week or every three weeks, depending on the chosen dosing-schedule. Radiotherapy and the combination of chemotherapy with radiotherapy may result in significant side effects and it’s important to know what to expect before starting treatment.

Early or acute side effects of radiotherapy occur while on treatment or within three months from starting. Late or chronic side effects may start after this. For head and neck cancers, some side effects start while on treatment and then persist as chronic or long-term effects.

Head and neck cancer radiation side effects

Mucositis  

Early on during chemo-radiotherapy, the mucous membranes of the oral cavity and pharynx may become inflamed. This may cause symptoms, such as pain and burning. Your doctor will usually prescribe mouthwashes and pain medication to help manage this.  

A patient undergoing chemo-radiotherapy may also be prone to the development of infections, like bacterial, viral or fungal infections, such as oral thrush. This may also be painful and require medication.

Skin  

Early skin effects which occur while on treatment include redness (erythema), dryness and itchiness (pruritus). As the patient progresses through treatment, areas of skin in the treated area may start to peel. 

This may be a dry peel (known as dry desquamation) or progress to a weepy, wet peel (moist desquamation) or even ulceration. 

Your doctor will explain how to care for the skin during chemo-radiotherapy to reduce the severity of the skin reaction. It’s important to avoid chemicals, sun exposure and anything else which may aggravate the skin reaction.

The early skin reaction usually heals with time but as a late effect, the skin in the treated area may become hard and stiff. This is known as fibrosis.

Sometimes there are pigmentation changes, such as darkening or lightening of the skin. 

Taste 

While on chemo-radiotherapy, a patient may experience a change and loss of taste sensation. This is often also accompanied by a change in sense of smell. The change in taste sensation usually starts within the first two weeks of treatment. Studies have shown that over time, taste sensation usually improves again, but this may take up to a year or even longer.  

Dry mouth

An early side effect which starts while on treatment but persists as a chronic complication is dry mouth (xerostomia). This happens because the salivary glands are very sensitive to the effects of radiotherapy.

This is a challenging side effect as it’s usually permanent, and even relatively low doses of radiotherapy may impair the function of the salivary glands.

Saliva is important to aid speaking, swallowing and is vital for general oral and dental hygiene. It’s important for patients to maintain a regular intake of water during and after treatment.  

Teeth

Before starting a radical course of radiotherapy to the head and neck area, a thorough dental assessment and cleaning should be done. Any teeth that are compromised should be extracted prior to starting radiotherapy. Otherwise the risk of complications, such as osteoradionecrosis (death of the cells of the jaw) and infection increases.

Tooth and jaw problems are compounded by other complications, such as dry mouth. So, it’s important to have a good oral care plan in place even after treatment is completed.  

Muscle and soft tissue stiffness

As a late effect of radiotherapy, the soft tissues and muscles of the neck may harden and become stiff. This is also known as fibrosis.  

Weight loss and malnutrition

These are problems commonly encountered by patients with head and neck cancers, either due to the tumour itself resulting in difficulty swallowing or chewing. But also due to the mucositis, dry mouth, taste change and pain experienced while on treatment.  

A dietitian may be able to help with a feeding programme. Some patients may need to have a feeding tube placed into the stomach if they are unable to maintain an adequate intake.  

Depression and anxiety

Many patients who need treatment for head and neck cancer may suffer from depression or anxiety. It’s important to recognise this and to seek help.

An intensive course of treatment for a serious medical condition takes its toll on both the patient and his/her loved ones. Don’t be afraid to reach out for help and support.

Other side effects

Depending on the exact area being treated, your doctor may also discuss potential effects to other organs, such as the eyes, middle ears, thyroid gland and brain.

If you’re uncertain about any aspect of your treatment, ask your oncologist to explain as it’s important for you to know what to expect.