Radiotherapy to the Head and Neck

Transcription

1 Radiotherapy to the Head and Neck Delivering the best in care UHB is a no smoking Trust To see all of our current patient information leaflets please visit

2 This leaflet has been given to you to provide some written information about the treatment that is being planned for you in addition to the explanations that you have received from your doctor. If you have any questions please get in touch with the specialist radiographers or clinical nurse specialists (contact details can be found at the end of this leaflet). What is radiotherapy? Radiotherapy is a treatment which involves precisely targeting high energy X-rays (ionising radiation) at a specific area with the aim of destroying any cancer cells there. In the same way that having a normal X-ray does not hurt, you will not see or feel anything whilst you are having radiotherapy. In certain situations some patients may benefit from having a form of radiotherapy known as Intensity Modulated Radiotherapy (IMRT). This technique permits the better shaping of dose around the tumour and helps to reduce the dose to healthy tissue. For example, this tends to be appropriate when we need to treat both sides of the head and neck yet want to try to reduce the dose to certain tissues within that area in order to minimise long term side effects, such as a dry mouth. There are several different machines that can give radiotherapy and IMRT. These include a linear accelerator which is a type of treatment machine that rotates around you and delivers a number of different beams from a variety of angles. Your treatment will be delivered by radiographers. A linear accelerator has an attachment which means that the radiographers can take low dose X-ray or CT images which they can then check and assess to ensure you are in the correct position. Another type of treatment machine is a TomoTherapy unit which is a combination of a CT scanner and a radiotherapy treatment machine. This machine works by performing a CT scan first to check that you are in the correct position and then delivers treatment. During the treatment the bed that you are lying on will move slowly through the machine. CT scans taken during treatment involve 2 PI_1344_02 Radiotherapy to the head and neck

3 a very small additional dose of dose X-rays. However these scans are important to ensure accurate treatment and overall serve to reduce the risk of side effects. These scans cannot be used to confirm how well the treatment is working. It is extremely important that you are not pregnant or become pregnant during your course of radiotherapy. Even a small amount of radiation may damage an unborn foetus so it is very important to let the radiographers know immediately if you think there is even a possibility that you may be pregnant before any radiation exposures are given on the CT scanner or treatment machine. Why do I need to have radiotherapy? The team of doctors involved in treating cancers of the head and neck have recommended that you receive a course of radiotherapy. Sometimes people who have radiotherapy will also have chemotherapy and your doctor will have discussed whether this is appropriate in your case. Are there any alternative treatments to radiotherapy? In some cases cancer can also be treated with surgery and you can discuss with your consultants whether any of these options are appropriate for you. Sometimes a combination of these treatments may be recommended. What are the benefits of radiotherapy? For most patients the benefits of radiotherapy are to cure the cancer or improve the symptoms of your cancer if the cancer itself is incurable. Your consultant will discuss this in more detail when you first see them. PI_1344_02 Radiotherapy to the head and neck 3

4 If you do decide to have radiotherapy, you will be asked to sign a consent form, stating that you have been informed of the risks and benefits. This does not mean that you cannot change your mind about your treatment choices. When is radiotherapy given? Radiotherapy is given every day, Monday to Friday in the radiotherapy department in the old Queen Elizabeth Hospital, for between three and seven weeks. Some days you will have additional appointments as from your second week of treatment you will also be seen weekly in your consultant s review clinic and by a dietitian. You may also need to have some blood tests once a week. What needs to happen before I start radiotherapy? Radiotherapy requires appropriate preparation and has to be carefully planned. Preparations include a dental assessment at which dental extractions may be advised and these have to be carried out prior to commencing the radiotherapy planning process. You will be invited to attend a pre treatment clinic appointment with members of the head and neck team at your local hospital before you start treatment. Radiotherapy can make it painful to swallow and difficult to eat; so you will be assessed by a dietitian and a speech and language therapist prior to starting your radiotherapy. It is important that you have a healthy, well balanced diet before you start your treatment as radiotherapy can affect your appetite and your ability to chew and swallow. If you are having difficulty with your nutrition or would like to ask any questions before your therapy then please mention these to your dietitian or your speech and language therapist. Your swallowing and eating and drinking will get more difficult and painful as you reach 4 PI_1344_02 Radiotherapy to the head and neck

5 the last few weeks of your radiotherapy treatment. During this time you will be encouraged to eat and drink orally, although you will probably need to opt for a softer or liquid diet. You will be seen by a dietitian every week and given advice and offered nutritional products to supplement your diet. If it is thought that your treatment is likely to cause you significant problems with eating and drinking, you may be offered a feeding tube before your treatment starts to ensure you can maintain your nutrition during this time. There are different sorts of feeding tube so if this is being considered for you then you will be invited to meet the nutrition nurses for them to assess and advise you. If you do not have a feeding tube fitted prior to starting radiotherapy and become unable to eat and drink enough because of the treatment, another option can be to have a nasogastric (NG) tube fitted during your radiotherapy. Again your doctors and nurses can give you more information about this if this is needed. What needs to happen for my radiotherapy to be planned? Whilst you are having your radiotherapy you will need to lie on a couch and wear a plastic mask (sometimes also known as a shell). Your first visit to the radiotherapy department is to the Mould Room where the mask is made. This mask is made between 1 and 3 weeks prior to starting your radiotherapy; it fits over your head and shoulders and is attached to the treatment couch. The mask is needed to ensure that you are in exactly the same position every day so that the treatment can be given very precisely to the correct area. Making the mask involves warming a sheet of a thermoplastic material so that it softens and can be gently draped over your head and shoulders and moulded to you. The mask then needs to stay in position for about ten minutes whilst it hardens and sets. The plastic is warm and feels a little like having a warm PI_1344_02 Radiotherapy to the head and neck 5

6 flannel over your face. The plastic has small holes in it so that you can still breathe easily. After the mask is made, usually on the same day, you will have a CT scan which is done with the mask on. The radiographers will put some marks on the mask so that when you return for your radiotherapy treatment it will be possible to have you lying in exactly the same position. The CT scan is normally done with contrast (dye) which will involve an injection into a vein. Before this injection is done the radiographers will ask you some questions and if you have ever had a reaction to contrast before then please let them know. The contrast is used as it shows some blood vessels and organs very clearly which makes it easier for the doctor to plan your radiotherapy. After your CT scan the radiographers will give you the details of your first radiotherapy treatment appointment and show you which room you will have treatment on. The radiographers will ask if you have a preference for a morning or afternoon appointment for your treatment and they will pass this onto the treatment radiographers. Please be aware that although the treatment radiographers will always try their best to give you appointments around your preference, it may not always be possible to accommodate these requests. If you require hospital transport for your radiotherapy treatment please discuss this with the CT radiographers. In between having your CT scan and starting radiotherapy a lot of work needs to be done, by your doctors and the team of radiographers and physicists, to plan and check your treatment. What happens when I come for radiotherapy? Your radiotherapy treatment will start on a weekday between 1 and 3 weeks after your CT scan. This appointment normally takes between 10 and 30 minutes. The radiographers will explain what is going to happen and then ask you to lie on the treatment couch where they will fit your mask in the same position as you 6 PI_1344_02 Radiotherapy to the head and neck

7 were in for your planning CT scan. The mask does need to be a close fit in order to do the job properly but it should not be painful. The radiographers will then move you into the correct position. If you are having treatment on a linear accelerator, the radiographers may move the machine around you to take some images prior to starting the treatment. These images are assessed to ensure that you are in the correct position; they cannot be used to assess the response of your cancer to radiotherapy. The treatment machine will then rotate around you so that the treatment can be delivered from a number of different angles. The machine will only be on for a few minutes at a time. You do not feel anything whilst the treatment is being delivered but you may hear the machine buzzing on and off. Alternatively, you may be having treatment on another type of machine known as a TomoTherapy unit. This looks very similar to a CT scanner and each day you will be positioned on the couch in the position that you were in for the planning CT scan. A CT scan will then be taken during which the bed will move through the machine. This scan will then be analysed along with the planning scan whilst you are lying on the couch. If needed, the couch position will be altered to place you in the correct position for treatment. Once you are in the correct position, treatment will then be delivered with you moving slowly through the machine. Regardless of which type of machine you are having your treatment on, the radiographers will ask you to stay as still as possible so that the treatment can be given to the correct place. The radiographers cannot stay in the room with you whilst the machine is on but they are operating the machine and watching you on cameras. If for any reason you need the radiographers then just raise a hand and they will immediately stop the treatment and come in. For both types of machines the total time that you are lying on the couch will be between 10 to 30 minutes approximately. PI_1344_02 Radiotherapy to the head and neck 7

8 What happens if I am having chemotherapy and radiotherapy? Not every patient who is receiving radiotherapy will also be having chemotherapy. If you are having chemotherapy this is not given every day. There are several different types of chemotherapy or drug treatments and these vary in when they are given. Your doctor will have discussed which one is the best one for you. Common scenarios are: Your schedule Radiotherapy Schedule Chemotherapy? Three weeks and one day No No Four weeks No No Chemotherapy in the week prior to radiotherapy? Six weeks No No Four weeks Four weeks Six weeks Six weeks Yes, once every week (Cetuximab) Yes (Carboplatin), once during the first week and once during the fourth week Yes (Cisplatin), once a week for the first five weeks Yes (Cisplatin), as an inpatient, once during the first week and once during the fourth or fifth week Yes (Cetuximab) No No No 8 PI_1344_02 Radiotherapy to the head and neck

9 Seven weeks Seven weeks Seven weeks Other Yes (Cisplatin), once a week for the first five weeks Yes (Cisplatin), as an inpatient, once during the first week, once during the fourth week and once during the seventh week Yes, once every week (Cetuximab) Yes (Cetuximab) Unless specified, all chemotherapy is given as an out patient on the chemotherapy day unit. There are also several head and neck trials running which involve slightly different treatment durations and chemotherapy regimes. If any of these are applicable to you then your doctor and a research radiographer or research nurse will discuss them with you and ask if you are interested in participating. What short term side effects may occur during my radiotherapy treatment? Whilst you are having your radiotherapy you will experience some side effects. These will not start immediately but will come on gradually and build up. These side effects can include: Tiredness A sore mouth which can cause pain and difficulty swallowing An altered sense of taste Skin reddening and soreness Thickened mucous and saliva secretions Hair loss to the area near to where the radiotherapy is delivered PI_1344_02 Radiotherapy to the head and neck 9

10 The side effects may also include hearing loss, severe pain that requires the use of strong analgesia and infections that could be life threatening. The symptoms are typically worst at the end of treatment and the period immediately afterwards. Although these side effects are common with all forms of radiotherapy they start to gradually improve a few weeks after treatment has finished. You will be seen daily by the radiographers when you come for your treatment and on a regular basis by your doctors and other members of the team, such as dietitians. As with any side effects, it is important that you mention them to the radiographers and doctors so that they can provide advice, and if necessary, prescriptions to help you manage these side effects. What are the long term side effects of radiotherapy? Long term side effects are classed as those that are present more than 3 months after radiotherapy. Severe effects are relatively infrequent but can include bone damage, hair loss, skin and cosmetic changes to the area where the radiotherapy was given, dental decay, difficulty in swallowing, dry mouth and a hoarse voice. A number of people will experience long term difficulties with eating and drinking due to a dry mouth, poor appetite or poor swallowing. Some may only be able to eat a pureed or soft diet, or take a long time to eat a meal; a small number of patients will require a permanent feeding tube. Uncommon side effects (less than 1 in 100) include nerve damage and associated disability. Ionising radiation carries a small risk of causing another cancer many years after treatment however this risk is extremely small compared to other factors such as tobacco. 10 PI_1344_02 Radiotherapy to the head and neck

11 Skin care As radiotherapy is likely to make your skin red, sore and possibly break in places, it is important to keep your skin clean and maintain good levels of hygiene as this can help reduce the reaction. Please tell the radiographers if you have an existing skin condition as we may need to advise you accordingly. The first signs of a skin reaction are a mild reddening, itching or warmth of the area being treated. The radiographers will monitor your skin very closely during your treatment. Please tell them if you have any problems with your skin, for example, if it is feeling itchy or sore, especially in areas that the radiographers are unable to see easily (e.g. behind your ears). If you develop a skin reaction the radiographers will give you advice on how to minimise these reactions and will provide you with any dressings if required. It is important to take care of your skin from the beginning of your radiotherapy treatment and so we suggest that you follow the advice below. This advice only refers to the skin in the treatment area. Washing You may wash the area during your radiotherapy treatment as follows: Use warm/tepid water. Use mild, unperfumed soap eg. Simple, ph 5.5, or Dove. Please check product labels carefully or ask a radiographer or nurse for advice Avoid soaking the treatment area in a hot bath/shower Avoid bubble baths, bath oils or shower gels Use a soft towel to pat the skin dry PI_1344_02 Radiotherapy to the head and neck 11

12 Hair removal Please avoid shaving or using any hair removal products. Radiotherapy does cause hair loss so if you have a beard you may wish to consider shaving it off prior to starting radiotherapy. Clothing It is best to wear loose fitting clothing made out of natural fibres, for example, cotton or silk, over the treatment area. These will not irritate the skin surface and will allow the area to breathe. Use of a moisturiser Your radiographers may give you a spray which acts as a barrier film to apply to your skin, this will help to minimise friction to the skin in the treatment area. The radiographers will explain how to use this. Please do not use a moisturiser in the same area as this product. If you wish to use a skin moisturiser during radiotherapy, suggested products include aqueous and Aveeno cream (both widely available) or calendula cream (available in health food shops). Some people may be allergic to certain moisturisers and may get a skin rash when using them. If you decide to use a new moisturiser during radiotherapy then please test it first on an area of skin not receiving radiotherapy. Not all skin care products are suitable for use during treatment. If you are using a different moisturiser for a pre-existing skin condition, please discuss this cream/ointment with your doctor or radiographers before applying. If you intend to apply a skin moisturiser prior to your treatment, ensure a thin layer is applied and that it has been fully absorbed into your skin before attending for your radiotherapy treatment. 12 PI_1344_02 Radiotherapy to the head and neck

13 Sun exposure Avoid exposing the treatment area to the sun during treatment and until all skin reactions have gone. Please do not use any form of sun protection cream during your radiotherapy treatment. Skin that has been treated with radiotherapy will be more sensitive to direct sunlight exposure. Once your treatment has finished, you should always protect the area by using at least SPF 30 sun block cream/lotion. Other considerations Make up, perfume, cosmetics and aftershave should not be used in the area being treated with radiotherapy Talcum powder should not be used on the skin in the area receiving radiotherapy. During your radiotherapy treatment course, the area being treated should be protected from the elements and extremes of temperature, for example, hot or cold packs. Other information Car parking Car park D is directly opposite the doors to the Cancer Centre on Mindelsohn Way. If you park here and bring in the ticket you have taken to access the car park, the radiographers in the treatment room will exchange this for a prepaid one so you can exit the car park. This has only been negotiated for patients who are attending for radiotherapy planning or treatment appointments so unfortunately the radiographers will not be able to give you a ticket if you are attending for a follow up appointment. PI_1344_02 Radiotherapy to the head and neck 13

14 Contact details Head and Neck radiographer: Radiotherapy dietitian: Clinical nurse specialists: Please use the space below to write down any questions you may have and bring this with you to your next appointment. 14 PI_1344_02 Radiotherapy to the head and neck

15 PI_1344_02 Radiotherapy to the head and neck 15

16 The Trust provides free monthly health talks on a variety of medical conditions and treatments. For more information visit Radiotherapy Department Cancer Centre Heritage Building (Queen Elizabeth Hospital) Mindelsohn Way, Edgbaston Birmingham B15 2TH Telephone: PI15/1344/02 Author: Rosemary Simmons and Paul Sanghera Date: October 2015 Review date: October 2017