Medicine

Patient information for Translation

Radiotherapy to the Head and Neck

Important: Please tell us if you have a pacemaker as we will need to monitor your heart during your treatment.

Please let us know if you are pregnant or think you might be pregnant.

It is important to remember that you need to use contraception whilst receiving treatment for cancer in order to prevent pregnancy – please see our leaflet ‘Avoiding pregnancy during radiotherapy and chemotherapy’.

Introduction

This leaflet provides information about radiotherapy treatment to the head and neck area.

Your clinical oncologist has decided that a course of radiotherapy would be the most appropriate way of treating your tumour. Whilst the treatment may have some side effects, it is felt that the advantages for you outweigh the disadvantages. You will be asked to sign a consent form to say that you are happy to proceed with treatment.

What is radiotherapy?

Radiotherapy is the use of high energy x-rays to treat tumours. It is delivered from a machine called a linear accelerator (Linac).

Treatments are usually scheduled daily, Monday through to Friday, for up to seven weeks; however, you may have more or fewer sessions depending on your treatment plan. You may also have chemotherapy at the same time as radiotherapy and this will be discussed with you in detail if it is required.

Radiotherapy treatment does not make you radioactive and it is safe for you to be around children and pregnant women.

It is very important that while you are having radiotherapy you do not become pregnant, or you do not get your partner pregnant, as radiotherapy and chemotherapy may harm the unborn baby.

What happens before radiotherapy treatment starts?

Dental check

You will need to see a dentist before you start your radiotherapy. This is to check that you do not have problems with your mouth such as loose or decayed teeth prior to treatment. You must attend this appointment before your radiotherapy can begin.

Help with nutrition

Getting the right nutrition throughout your treatment is important. Your doctor may recommend that you have a temporary feeding tube fitted into your stomach and this would require a short stay in hospital. The tube would stay in place until your treatment ends. This will be discussed with you before an appointment is made for the procedure to take place.

You will also be seen weekly during your treatment by a specialist dietician to ensure you are getting the necessary nutrition.

Meeting with the speech and language therapy team

Specialist speech and language therapists will see you before and during your treatment to help with your chewing, swallowing, and speech. Radiotherapy can make eating and swallowing more difficult, and the speech and language therapy team will provide specialist advice and exercises to keep your eating and swallowing working as well as possible.

Radiotherapy planning

Once your dental checks are complete you will be contacted with a date to attend for the pre-treatment procedure – also known as ‘radiotherapy planning’. The planning is a crucial step where we will decide the best position for you to lie in.

Your position will be the same each day for treatment.

The mould room

The head and neck area is very complicated and has many important structures. The aim of radiotherapy planning is to treat the tumor area whilst avoiding healthy structures. It is therefore very important you keep your head absolutely still during treatment. For this reason, a plastic mask will be made for you to wear during your planning and treatment. The mask will have alignment marks drawn on it for the radiographers to use during treatment.

What is a mask?

An impression of your face, head and neck is taken to produce a personalised immobilisation device used for treatment.

The mask is made from a thin sheet of plastic material containing holes through which you can breathe. This material is then heated in warm water, so it moulds to the shape of your head and neck. The mask then cools down on you, so it sets to your shape. It takes about 15 minutes to make the mask but please allow at least 60 minutes for your whole appointment. The picture shows what your mask may look like once made.

If you wear a piecing or jewellery in the area where the mask is going to be made, they will need to be removed. If you wear false teeth, let us know, so we can decide whether they remain in during treatment or that you take them out.

It is important for the mask to fit, so do not have your hair cut after the mask is made, and maintain the same hair style throughout treatment.

If you have a beard, we recommend you shave it off before coming to have your mask made. Only use an electric razor, do not wet shave whilst on treatment, as this can irritate the skin.

You will then have a CT scan with your mask on, and this will be used to plan your radiotherapy.

Your next appointment will usually be in a couple of weeks after this planning scan.

Treatment

Before your first treatment, a radiographer will discuss what the treatment involves and will re-cap the side effects and how to take good care of yourself throughout your treatment. You will be given a list of all your appointments. You may be asked to change into a gown each day before you have treatment.

Once you are taken into the treatment room you will be positioned on the treatment couch and your mask will be carefully fitted. The couch will be raised so it is important you do not attempt to get off. The machine is controlled by the radiographers outside the treatment room.

You are watched at all times on a close circuit television monitor (CCTV). The mask can be removed at any time; you just need to raise your hand and a radiographer will assist you with this. If the radiographers have left the room, you will need to give them time to come in to take the mask off.

Your first treatment is usually the longest as extra safety checks are done at this visit. Each treatment session usually lasts between 10 - 20 minutes. This time includes getting you in the correct position and delivering your treatment. The radiographers see and monitor you daily if you have any problems please let them know. You will also be seen on a weekly basis by the doctors, specialist head and neck radiographer, dietician, speech therapist, and nurses. Your radiographers will organise referrals as required.

Minimising side effects

There are certain things you can do before starting your treatment to minimise the side effects:

Eating and drinking

It is important to drink plenty of fluids throughout your treatment. You should aim to drink around 1.5-2 litres a day. Try carrying a bottle around with you and taking small, regular sips. It is also very important to try and maintain your weight throughout your radiotherapy, even if you do not feel like eating. Try small meals more often, or softer foods. You will be seen weekly by the dietician who will give extra advice and help.

Alcohol

Alcohol can also make mouth soreness worse. Avoid alcohol if you can, especially neat spirits.

Stop smoking

Stopping smoking during and after radiotherapy is very worthwhile. Research shows that stopping may make the radiotherapy more effective as well as reducing side effects.

Your radiotherapy team and refer to you for help with stopping smoking.

Smoking Cessation clinic

St Bartholomew’s Hospital

King George’s Building (KGV) Clinic 1A

Drop-in clinic: Every Wednesday 9am-1pm

Expected side effects

Thick/sticky saliva and dry mouth

If your mouth is in the treatment area you will notice that your saliva becomes thicker and stickier than normal. We encourage you to drink plenty of fluids and to do regular mouthwashes with the mouthwash we provide. Sucking sugar-free sweets or chewing sugar-free gum can help with saliva production.

After your treatment course finishes your mouth may become very dry. It can take a while for your saliva production to recover (up to 18 months) and it may never fully recover to the levels from before your radiotherapy.

Taste changes

During treatment you may also notice a metallic taste and you could lose your taste altogether by the end of your course. Your sense of taste can take up to 4-6 months to return after treatment finishes.

Voice changes

You may find your voice becomes more hoarse and deep as the treatment progresses. A small number of patients find that they cannot speak above a whisper. Try to rest your voice as much as possible.

Hair loss

Any hair within the treatment area will gradually fall out. The radiographers will be able to show you the exact area being treated so you will know what to expect. In most cases the hair will re-grow when you have finished treatment.

Tiredness

It is quite common to feel more tired than normal during treatment. Rest if you need to, but if you feel OK you should carry on with all your normal daily activities. Tiredness may continue for some time after the end of treatment.

Mouth and throat soreness

The inside of your mouth and throat may gradually become sore and inflamed, and you can develop ulcers. It is important to maintain good oral hygiene throughout your treatment. The nurses can help you with this if you are having difficulties or are unsure what you should do. You will be given a mouthwash to use during treatment. You are advised to use a soft or child toothbrush to clean your teeth. If your mouth becomes painful, please let us know so that appropriate pain relief can be given. If you wear dentures it may become more painful to wear them during your treatment. You may feel more comfortable not wearing them but will need to keep them in if your mask was made with the dentures in place.

Brushing your teeth

During treatment, please brush your teeth using a soft baby toothbrush. Details about dental hygiene after treatment will be provided by the specialist dentist. It is common to be given high-fluoride toothpaste to use when your treatment is finished.

Getting back to normal

Side effects of radiotherapy can continue for up to two weeks before starting to improve. Therefore, please keep using the recommended creams and medicines throughout the first few weeks after completing your treatment.

Be careful not to over-expose the treated area to the sun. The skin in the treatment area will be more sensitive to the sun for the rest of your life and we recommend you use a very high factor sun block (factor 50). Try to avoid exposing your skin to extremes in weather temperatures by using a hat for shade in the summer and soft scarfs in the winter.

You will be seen again by the speech and language team, and you may also be referred to the community dietician, for continued support with your swallowing and nutrition.

You will be kept on a follow up regime by your radiotherapy doctor. If you have any questions or concerns then please feel free to talk to your CNS (cancer nurse specialist) or the specialist head and neck radiographer.

Maggie’s Centre at St Barts

Finishing cancer treatment can be unnerving and can cause a lot of stress both physically and emotionally.

The Maggie’s Centre at St Bartholomew's Hospital is a facility which provides patients and family with free practical, emotional and social support.

It also offers many workshops including yoga, dance classes, information drop in clinics and counselling on a one-to-one basis as well as group sessions.

Contact us

Radiotherapy

Radiotherapy Basement, King George V

Wing (KGV), St Bartholomew’s Hospital, West Smithfield, London EC1A 7BE

020 3465 5222 Radiotherapy Reception (Mon-Fri 8.45am-5pm)

07917 093 738 Emergency Hotline (when the department is closed)

Maggie’s Centre @ St Barts

St Bartholomew’s Hospital, West Smithfield, London, EC1A 7BE

Tel: 0203 904 3448 

Drop in Mon-Fri: 9am-4pm 

https://www.maggiescentres.org/our-centres/maggies-barts/

Macmillan Cancer Information Centre

Vicky Clement-Jones

Ground Floor, West Wing, St Bartholomew’s Hospital.

Just drop in Mon-Fri 10am-12noon and 2-4.30pm. Or call on

020 3465 6611.

If calling outside working hours, ring Macmillan free on 0800 808

00 00 or visit the Macmillan website.

Large print and other languages
This information can be made available in alternative formats, such as easy read or large print, and may be available in alternative languages, upon request. For more information, speak to your clinical team.
 

এই তথ্যগুলো সহজে পড়া যায় অথবা বৃহৎ প্রিন্টের মত বিকল্প ফরম্যাটে পাওয়া যাবে, এবং অনুরোধে অন্য ভাষায়ও পাওয়া যেতে পারে। আরো তথ্যের জন্য আপনার ক্লিনিক্যাল টিমের সাথে কথা বলুন।

Na żądanie te informacje mogą zostać udostępnione w innych formatach, takich jak zapis większą czcionką lub łatwą do czytania, a także w innych językach. Aby uzyskać więcej informacji, porozmawiaj ze swoim zespołem specjalistów.

Macluumaadkaan waxaa loo heli karaa qaab kale, sida ugu akhrinta ugu fudud, ama far waa weyn, waxana laga yabaa in lagu heli luuqaado Kale, haddii la codsado. Wixii macluumaad dheeraad ah, kala hadal kooxda xarunta caafimaadka.

Bu bilgi, kolay okunurluk veya büyük baskılar gibi alternatif biçimlerde sunulabilir, ve talep üzerine Alternatif Dillerde sunulabilir. Daha fazla bilgi için klinik ekibinizle irtibata geçin.

یہ معلومات متبادل فارمیٹس میں دستیاب کی جا سکتی ہیں، جیسا کہ پڑھنے میں آسان یا بڑا پرنٹ  اور درخواست پر متبادل زبانوں میں بھی دستیاب ہو سکتی ہیں۔ مزید معلومات کے لیے، اپنی کلینکل ٹیم سے بات کریں'۔

Patient Advice and Liaison Service (PALS)

Please contact us if you need general information or advice about Trust services: www.bartshealth.nhs.uk/pals

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Reference: BH/PIN/1005

Publication date: Aug 2020

All our patient information leaflets are reviewed every three years.

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