Having external radiotherapy for nasopharyngeal cancer
Radiotherapy uses high energy x-rays to treat cancer. It's one of the main types of treatment for nasopharyngeal cancer.
How do you have radiotherapy?
You have your treatment in the hospital radiotherapy department. You have treatment once a day, from Monday to Friday, with a break at the weekends. The length of the course of treatment varies but it is usually between 5 and 7 weeks.
You usually have a form of external radiotherapy called intensity modulated radiotherapy (IMRT).
When you might have radiotherapy
Radiotherapy on its own
Having radiotherapy on its own is often the first choice of treatment for stage 1 and some stage 2 nasopharyngeal cancers.
Whether this type of treatment is suitable for you depends on:
- the size of the cancer
- how far it has grown into the surrounding tissues
- exactly where the cancer is
Radiotherapy to the lymph nodes in the neck
You usually have radiotherapy to lymph nodes in the neck. You are likely to have this even if there might not be signs of cancer in the lymph nodes. This is to reduce the risk of cancer coming back in this area.
Radiotherapy to treat nasopharyngeal cancer that has come back
You might have surgery or radiotherapy or both. You might also have chemoradiotherapy. For cancer that has come back in the lymph nodes you usually have surgery to remove the lymph nodes. Radiotherapy may also be an option if surgery is not possible.
Radiotherapy with chemotherapy (chemoradiotherapy)
You might have radiotherapy and chemotherapy. This is called chemoradiotherapy. You usually have chemoradiotherapy for:
- some stage 2 nasopharyngeal cancers that have a higher risk of coming back after treatment
-
cancer has grown into your
lymph nodes 
or tissues around your nasopharynx (locally advanced cancer)
You might have chemotherapy once a week or once every 3 weeks.
Chemotherapy can make the cancer cells more sensitive to the radiotherapy.
Radiotherapy for advanced nasopharyngeal cancers
Cancer that has spread to other parts of the body is called advanced cancer. Advanced nasopharyngeal cancer is usually treated with chemotherapy. You might also have radiotherapy. Some people might also have targeted treatments.
Radiotherapy to relieve symptoms
Radiotherapy can relieve symptoms in people with nasopharyngeal cancer that has spread to another part of the body. This is called palliative radiotherapy.
Your cancer may cause difficulty in swallowing or breathing or pain in your bones. Radiotherapy may relieve these symptoms.
To control symptoms, you are most likely to have a short course of treatment over a few days.
Types of radiotherapy for nasopharyngeal cancer
Intensity modulated radiotherapy
There are different types of external radiotherapy. You usually have a type of radiotherapy called intensity modulated radiotherapy (IMRT).
This treatment directs a precisely targeted dose of radiation to the area of the cancer from outside the body.
With IMRT there is less normal tissue in the treatment area. So the risk of side effects is lower. But you are likely to have some side effects.
Stereotactic radiotherapy
Stereotactic radiotherapy is another form of external radiotherapy. This gives radiotherapy from many different angles around the body. All the radiation beams meet where the cancer is. So the cancer gets a very high dose of radiation and the areas around it get a much lower dose. This helps to reduce side effects. You may have this treatment in a single session.
You are more likely to have stereotactic radiotherapy for nasopharyngeal cancer that has come back near to where it started (local recurrence).
The radiotherapy room
Radiotherapy machines are very big and could make you feel nervous when you see them for the first time. The machine might be fixed in one position. Or it might rotate around your body to give treatment from different directions. The machine doesn't touch you at any point.
Before your first treatment, your will explain what you will see and hear. In some departments, the treatment rooms have docks for you to plug in music players. So, you can listen to your own music while you have treatment.
It is important to lie in the same position each time, so your radiographers may take a little while to position you on the couch. You have a mask around your face to keep your head still, which they attach to the couch. They make sure your mask feels comfortable.
Once you are in the right position they leave you alone in the room.
During the treatment
You need to lie very still. Your radiographers might take images (x-rays or scans) before your treatment to make sure that you're in the right position. The machine makes whirring and beeping sounds. You won’t feel anything when you have the treatment.
Your radiographers can see and hear you on a CCTV screen in the next room. They can talk to you over an intercom and might ask you to hold your breath or take shallow breaths at times. You can also talk to them through the intercom or raise your hand if you need to stop or if you're uncomfortable.
This video shows what happens during the treatment. The video lasts 1:17 minutes.
Daniel (radiographer): Before your treatment starts your doctor will need to work out exactly where the treatment needs to go and also which parts need to be avoided by the treatment.
To have radiotherapy you lie in the same position as you did for your planning scans.
To stop you moving and to make sure your treatment is directed at the cancer you wear a custom mask over your face which is attached to the couch.
We line up the machine using marks on your mask and then leave the room. We control the machine from a separate room this is so we aren’t exposed to radiation.
Treatment takes a few minutes and you’ll be able to talk to us using an intercom. We can see you and hear you while you’re having treatment and we will check that you’re OK.
When your treatment starts you won’t feel anything. You may hear the machine as it moves around you giving the treatment from different angles.
Because we’re aiming to give the same treatment to the same part of the body every day the treatment process is exactly the same everyday so you shouldn’t really notice any difference.
You’ll see someone from the team caring for you once a week while you’re having treatment. They’ll ask how you are and ask about any side effects.
You won't be radioactive
This type of radiotherapy won't make you radioactive. It's safe to be around other people, including pregnant women and children.
Smoking
If you smoke, your doctor will advise you to give up before you start treatment. Radiotherapy might not work as well and you may have more side effects if you continue to smoke.
Travelling to radiotherapy appointments
You might have to travel a long way each day for your radiotherapy. This depends on where your nearest cancer centre is. This can make you very tired, especially if you have side effects from the treatment.
You can ask the for an appointment time to suit you. They will do their best, but some departments might be very busy. Some radiotherapy departments are open from 7 am till 9 pm.
Car parking can be difficult at hospitals. Ask the radiotherapy staff if you are able to get free parking or discounted parking. They may be able to give you tips on free places to park nearby.
Hospital transport may be available if you have no other way to get to the hospital. But it might not always be at convenient times. It is usually for people who struggle to use public transport or have any other illnesses or disabilities. You might need to arrange hospital transport yourself.
Some people are able to claim back a refund for healthcare travel costs. This is based on the type of appointment and whether you claim certain benefits. Ask the radiotherapy staff for more information about this and hospital transport.
Some hospitals have their own drivers and local charities might offer hospital transport. So do ask if any help is available in your area.
Side effects
Radiotherapy can cause side effects. These are generally in the areas treated. They include a sore mouth and throat and sore, red skin in the treatment area.
