Targeting cancer - Radiation therapy treatment process
Targeting cancer - Radiation challenges and what helped
Targeting cancer - How the radiation immobilisation mask is made
Targeting cancer - Side effects of radiation therapy

Radiation therapy

The most common radiation therapy approach for nasal and para nasal sinus cancers is called external beam radiation. This type of radiation therapy applies radiation from outside the body.

Radiation therapy can be used in the following ways: 
Definitive  This is the main treatment for nasal and para nasal sinus cancer. It is used without surgery to cure nasal and para nasal sinus cancers. Definitive radiation therapy can also be given in combination with chemotherapy (called concurrent chemoradiation). The decision to give radiation therapy, alone or in combination with chemotherapy depends on the type of tumour, how big it is and how fit and strong you are. Typically radiation therapy is delivered one each week day (not on weekends) over 7 weeks.
Neo-adjuvant This is when radiation therapy is given before surgery to help shrink large cancers so they are easier to remove during surgery. Sometimes chemotherapy is added to radiation therapy (chemoradiation) to make it more effective.
Adjuvant This is when radiation therapy is given after surgery. It is used as an additional treatment to kill cancer cells that may not have been removed during surgery. This typically starts about 4 weeks after surgery to give you time to recover from the surgery. The radiation therapy usually lasts for about 6 weeks. Sometimes chemotherapy is added to the adjuvant radiation therapy (chemoradiation) to make it more effective.
The decision to give radiation therapy, either alone or in combination with chemotherapy, is based on the pathology results after surgery and how fit and strong you are to cope with the treatment. The aim is to lower the risk of the cancer coming back again in the nose, sinuses or neck but, not all patients need this.
Palliative In cases where a cure is not possible, radiation therapy is used to relieve symptoms of advanced nasal and para nasal sinus cancer. Symptoms that may require palliative radiation therapy include pain, bleeding and pressure symptoms pressing on vital structures (e.g. visual disturbance and headaches).

How do I prepare for radiation therapy? 

You will meet with many members of the cancer care team, who will help you learn how to look after yourself through radiation therapy, recovery and long term follow-up. They will also talk to you about side effects and how to manage them. It may be helpful to write down questions as they come up, so you can ask anyone in your cancer care team when you see them.

 

Radiation therapy mask-making and simulation 

  • Radiation therapy is a precise treatment. In order to make sure, that the cancer is covered by the treatment, you will need to be very still during the treatment, usually for about five minutes. A radiation therapy mask that is made to fit perfectly to your shape, will be put on you during each treatment to help the machine target where the cancer is.
  • You will have a planning CT scan (and sometimes other scans) with the mask on. Your radiation oncologist and radiation therapists will use these scans with all your other clinical information to develop a radiation therapy plan just for you (a personalised plan). Your plan will be checked by the radiation therapy and radiation oncology physics team before it is ready to be used for your treatment. This whole process can take approximately 2-3 weeks.
 

Teeth and mouth care

You might need to have some of your teeth taken out, this will depend on the area being treated and the dose of radiation therapy. It is important to take out any broken or infected teeth before radiation therapy. Taking out unhealthy teeth after radiation therapy can cause problems with the jaw bone. Further information about removing teeth and what to expect before and after the operation is available here

 

 

Diet and nutrition

Your cancer and its treatment can make it hard to eat and drink. Your doctor will recommend you see a dietitian to maximise your nutrition during treatment as well as while you are recovering. Sometime feeding tubes may be recommended depending on the area being treated and the dose of radiation therapy.
There are two common types of feeding tubes: 

  • Gastrostomy tube (sometimes called a PEG tube): this type of tube is inserted through your abdominal wall into your stomach, with part of the tube staying outside the stomach.  A syringe can be attached to the tube to give you food this way if needed. The tube is inserted using a camera through the mouth into the stomach (gastroscopy) or using a CT scanner to guide insertion directly through the skin. If a PEG tube is needed, your doctor will organise this before starting your radiation therapy

  • Nasogastric tube: this type of tube goes through the nose down into the stomach and is usually used for short periods (days or weeks). A nasogastric tube can be inserted at any time (before, during or after treatment).

 
 

Speech, voice and swallowing
 

Your cancer and its treatment can make swallowing and speech difficult. Your doctor will recommend you see a speech pathologist, who can help you with ways to manage swallowing and communication difficulties, during and after treatment.

 

 

There are many other aspects of supportive care that are available, ask your doctor if you have any specific needs.

Side effects

The side-effects of radiation therapy start around two weeks into treatment and progress through treatment to peak in the last week or just after treatment ends. The side effects start to improve 2-3 weeks after the end of treatment.

Side effects associated with radiation therapy depend on:
  • the dose of radiation therapy

  • the area being treated

  • whether or not chemotherapy is added to the radiation.

Each person responds to radiation therapy differently. Some people may experience a few side effects while others may not experience any at all. The following are some common side effects of radiation therapy.

Common side effects of radiation therapy include:
  • tiredness

  • skin irritation in the treated area e.g. redness, dryness and itching, weeping skin, scaling or sometimes skin breakdown (sores)

  • nasal irritation, blockage and crusting

  • dry mouth and throat due to lack of saliva (called xerostomia)

  • altered taste, which is usally a loss of taste or sometimes an unpleasant taste in the mouth

  • pain on swallowing or difficulty with swallowing.

Most side effects are short lived and may go away within 4–6 weeks of finishing radiation therapy. Some side effects may last for months after you finish radiation therapy and some may be permanent.

Rare side effects from nerve damage (called cranial neuropathy) may occur following treatment of very advanced cancers. These include difficulty speaking, swallowing, impaired and double vision. The nasal and paranasal cavity is very close to a number of important structures such as the spinal cord, brain and nerves involved with vision, hearing and balance. Your radiation oncologist will be very careful to avoid these structures by using very precise radiation therapy techniques but sometimes rare side effects may occur from the radiation therapy. You can talk to your radiation oncologist to find out if these concerns apply to your situation and to find out more about these rare side effects.

Once your radiation therapy ends, you may continue to have follow-up appointments so that your doctor can check your recovery and monitor any side effects that you may have. Sometimes your doctor may arrange for a PET scan about 12 weeks after finishing radiation therapy to make sure the cancer has completely gone.

Your doctor may recommend that you receive specific supportive care to help during your treatment and recovery.