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Radiotherapy| treats cancer by using high-energy rays to destroy the cancer cells, while doing as little harm as possible to normal cells.
Radiotherapy can be used to treat laryngeal cancer in the following ways:
Treatment is usually given as a series of short, daily treatments in the hospital radiotherapy department. The treatments are normally given from Monday-Friday, with a rest at the weekend.
However, sometimes you may also have treatment at the weekend, or more than one treatment each day - this is called hyperfractionation. It’s important to follow the treatment plan and avoid any unnecessary gaps in your course of treatment.
Radiotherapy treatment usually lasts 3-7 weeks, depending on the type and size of the cancer. Your clinical oncologist will discuss your treatment plan and any possible side effects with you.
Radiotherapy is carefully planned to make sure it’s as effective as possible. The radiotherapy is aimed very precisely at the area of the larynx. It’s important that you are able to lie still in exactly the same position each time the treatment is given. To help you to do this, a special mask (or shell) of your head and shoulders is made. The shell fits over your head and neck and is then fixed to the treatment couch. This holds you firmly in the right position.
The mask is made on one of your first visits to the radiotherapy department. It’s made in the mould room of the radiotherapy department by a mould technician or radiographer (the person who gives the radiotherapy treatment). The process of making the mask can vary slightly between hospitals but it usually takes about 30 minutes. There are two techniques to make a mask: one uses wet plaster bandages and then the finished mask is made of perspex (a type of plastic); and the other uses a type of mesh plastic, which is moulded to fit the shape of your face.
Our radiotherapy section has more information about radiotherapy masks|.
Your treatment will be planned by a clinical oncologist. You may need to make a few visits to the radiotherapy department to plan the radiotherapy. You will have a CT (computerised tomography) scan| taken of the area to be treated. This scan takes lots of images from different angles to build up a three-dimensional picture of the area. At the same time, the radiographers will take measurements from you that are needed for treatment planning.
You will need to wear the mask for the planning sessions, and won’t be able to speak while you have the mask on. However, the radiographers will tell you how to signal to them if you want to communicate.
Marks are drawn on the mask to help the radiographer position you accurately and to show where the radiotherapy rays will be directed.
The radiographer’s measurements and the information from the scans are fed into a planning computer that’s used to help your doctors plan your treatment precisely. The planning process may take 7-10 days to complete, and then the actual treatment can start.
Before each session of radiotherapy, the radiographers will position you carefully on the couch with the mask fitted. They will make sure that you are comfortable.
The treatment only takes a few minutes. During this time you will be left alone in the room. However, you can signal to the radiographers, who will watch you on a television monitor from the next room. You have to lie still while the treatment is given, but you won’t feel the radiotherapy. It’s similar to having an x-ray.
Before you start your treatment, your doctor will explain the likely side effects and how they can be controlled. Radiotherapy to the larynx can cause the following side effects:
The skin at the front of your neck will become red or darker. Dark skinned people may find their skin gets darker or develops a blue or black tinge. It will also become sore and feel like sunburn. The changes to the skin begin to appear about two weeks after the treatment has begun, and may continue until about 2-4 weeks after it has ended. When you are outside, protect your skin from the sun or cold winds with a silk or cotton scarf.
Sometimes the skin may peel or crack. The staff in the radiotherapy department will advise you on how to look after your skin during the treatment. They may prescribe creams or lotions for you to use if your skin becomes very sore. If the skin on your neck peels, you may need a dressing on the area. This can be done by a district or practice nurse at your GP surgery.
The radiotherapy staff will also advise you about how to look after your skin in the area being treated. Some chemicals in soaps, creams, perfumes or beauty products can make your skin more sensitive to the effects of radiotherapy, so you shouldn’t use any soaps, creams or lotions on your skin in the treatment area without asking the radiotherapy staff first. Men should not wet shave during radiotherapy but can use an electric razor.
Avoid using perfumes and aftershave until the skin has healed. Even once the skin has recovered, it may always be slightly darker than before. For at least the first year after your radiotherapy, it’s important to protect the treated area from strong sunshine. Even after this time, the area of treated skin will be more delicate than normal, so take extra care. Use a suncream with a sun protection factor (SPF) of at least factor 15 and cover the area with a light scarf. It’s important to remember that you can burn even through clothing if you are out in hot sun for a long time.
Radiotherapy can cause the lining of your throat to become sore and inflamed, which can make it difficult to swallow. Your doctor can prescribe liquid painkillers to ease this. You will be given advice on foods that are easy to swallow, and you may be given some nutritious high-energy drinks. Most people manage to eat foods that are soft and moist until the soreness has settled. This usually occurs a few weeks after the treatment has finished.
Some people find that their throat becomes so sore it stops them from eating and/or drinking enough. This is more common when radiotherapy and chemotherapy are given at the same time. If this happens, you’ll be seen by a dietitian who will prescribe nutritional support (enteral nutrition). This is where liquid containing all the nutrients you need is given directly into the gut through a tube that goes into your stomach or small intestine. Liquid medicines can also be given through the tube.
Enteral nutrition can be given in two ways:
You may start enteral nutrition before your radiotherapy begins. Your doctor and dietitian will discuss this with you, and decide which type of feeding system is most suitable for you.
Our nutritional support section| has more information about nasogastric, PEG and RIG tube feeding.
Radiotherapy may cause swelling in your throat. Rarely, the swelling can lead to breathing problems, which must be treated straight away. If you develop any breathing difficulties, or if your breathing sounds different, tell a doctor or contact the hospital as soon as possible. Very rarely, an operation to help you breathe (temporary tracheostomy) is required.
Radiotherapy treatment to the larynx can affect the salivary glands, meaning that less saliva is produced. This means the lining of your throat or mouth may become dry| during treatment. Sometimes the dryness can continue for a long time after the treatment has finished. You may notice a feeling of sticky mucus in the throat, which will gradually clear up. You may also have a persistent tickly cough for a while.
Your voice may already be hoarse before you start the treatment. It’s likely to become more hoarse (or may even be lost completely) during the radiotherapy. Your voice will then gradually improve and get stronger over the following weeks and months after your treatment is finished. Your doctor will let you know about the risk of permanent voice changes. A speech and language therapist can advise you on voice exercises to speed up your recovery - your doctor or specialist nurse can arrange this for you.
Some people find that they lose their appetite. If you don’t feel like eating, your doctor or a dietitian can prescribe nutritious, high-energy drinks| to supplement or replace your meals until your appetite comes back.
Our diet| section has some helpful hints on how to eat well when you are feeling ill, or if you find swallowing painful.
The loss of appetite may be at its worst towards the end of the course of treatment and during the first couple of weeks after your treatment has finished. Your doctor will let you know what to expect. They can also arrange for you to see a dietitian.
Your sense of smell and taste may change or become dulled during treatment and for a few months afterwards.
Radiotherapy to the throat does not affect the hair on your head, but men will lose their beard (usually permanently) from the areas of skin that are treated.
Radiotherapy often causes tiredness (fatigue)|. It’s helpful to get as much rest as you can, especially if you have to travel a long way for treatment each day. Fatigue may increase towards the end of your treatment, and may last for many months after treatment has finished. Try to plan your day so that you have time for rest and to do the things you want to do most. Light exercise like walking can help to improve fatigue.
Radiotherapy does not make you radioactive and it’s perfectly safe for you to be with other people, including children and pregnant women, throughout your treatment.
Radiotherapy for laryngeal cancer is currently given using a technique called three-dimensional conformal radiation therapy (3D-CRT). Conformal radiotherapy uses the same radiotherapy machine as normal radiotherapy treatment. However, a device called a multi-leaf collimator is used to arrange the shape of the beams so that they ‘conform’ to the area of the cancer. This ensures that a higher dose of radiation is given to the tumour. Healthy surrounding cells and nearby structures receive a lower dose of radiation, so the possibility of side effects is reduced.
Intensity-modulated radiotherapy (IMRT) is a new type of radiotherapy that is able to shape treatment beams more precisely than 3D-CRT. This allows the dose of radiotherapy to be changed in different parts of the larynx and surrounding tissues. This can reduce the side effects of treatment. Your doctor can tell you if IMRT is suitable for you.
IMRT is not widely available so you may need to travel for this treatment.
Content last reviewed: 1 April 2011
Next planned review: 2013
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