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Internal radiotherapy for mouth cancer

Men and women discussing mouth cancer

This page has information about treating mouth and oropharyngeal cancers with internal radiotherapy. You can find information about

 

A quick guide to what's on this page

Internal radiotherapy for mouth or oropharyngeal cancer

Internal radiotherapy is also called brachytherapy or interstitial radiotherapy. It uses a radiation source inside your body to give radiotherapy to the cancer. The source is put within the cancer or very close to it. 

The tumour gets a high dose of radiation without damaging surrounding tissue. Internal radiotherapy can often cure small tumours in the lip, tongue, soft palate, cheeks, neck, tonsil or floor of the mouth. It may cause less physical changes and loss of function compared to other types of treatment.

Doctors use internal radiotherapy to treat small tumours. It can also treat cancers that have come back after earlier treatment with external radiotherapy. Or it can be used as a booster dose at the end of a course of external radiotherapy.

How you have internal radiotherapy

You can have internal radiotherapy to the mouth in two different ways -  permanent implants or interstitial radiotherapy.

Permanent implants

Some implants are made of radioactive gold seeds which are left in place permanently in the tumour. The amount of radiation they give off is small and can only travel a short distance. You have a private room on the room where you stay following the procedure for one night, so that other people are not exposed to the radiation.

The tumour gets nearly all the radiation dose with very little effect of surrounding tissues and organs. It is not a risk to you or anyone around you.

Interstitial radiotherapy

You have tubes put into your tumour under general anaesthetic. The tubes stay in place until the treatment is over. For the treatment, the tubes are connected to a brachytherapy machine which contains a radiation source. The source travels out of the machine and into the tubes, releasing a dose of radiation to the tumour.  

Implants in your mouth can be uncomfortable and make eating and talking difficult. You may need a soft or liquid diet. A speech and language therapist helps you to communicate and makes sure that you can swallow well.

You have another general anaesthetic to have the implant taken out. You are likely to feel sore for a while afterwards.

 

 

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What internal radiotherapy is

Internal radiotherapy (also called brachytherapy) uses a radiation source inside your body. The radiation source is the substance that gives off the radiation. It may be positioned actually within the cancer or very close to it. This way, the tumour gets a high dose of radiation without damaging surrounding tissue.

You can have internal radiotherapy

  • On its own to treat a small tumour
  • If your cancer has come back after earlier treatment with external beam radiotherapy, or
  • As a booster dose at the end of a course of external radiotherapy
 

Benefits of having internal radiotherapy

The benefits of using internal radiotherapy for mouth and oropharyngeal cancers are

  • It reduces physical changes and loss of function in the area being treated compared to other treatments
  • Nearby structures such as the brain, spinal cord and eyes don't receive high doses of radiation
  • It can be used in high doses for tumours that can’t be treated any more with external radiation (called salvage brachytherapy)
 

Radioactive permanent implants

Radioactive implants are sometimes used to treat head and neck cancers. They are put into the cancer and surrounding tissues. They are small radioactive pellets which are the size and shape of a grain of rice. They are usually made of gold. Once the doctor has put them into the tumour, they stay there forever. 

They contain a small level of radiation which eventually loses its strength over a few weeks. The radiation can only travel a short distance and the tumour gets nearly all the radiation dose, with very little effect of surrounding tissues and organs. It is not a risk to you or anyone around you.

The doctor places these pellets in the tumour when you are under a general anaesthetic. You have to stay on the ward in a isolated room for the first night following the procedure. This is because the radioactivity in the pellets is at its strongest and other people can't be exposed to the radiation.  

Afterwards you are free to go home and your doctor usually calls you back after 6 weeks to have a CT scan. This is to check the pellets are still in place and haven't moved. 

Your doctor also gives you a card to carry for a certain amount of time. The is to be shown to your dentist or any hospital staff when you have a procedure. Let your next of kin know about the card and procedure incase you end up in hospital, and are unable to give the information yourself. This is to alert the staff that you have these pellets in you, before you have any other procedure.

This type of brachytherapy can often cure small tumours in the

  • Lip
  • Tongue
  • Soft palate
  • Cheeks
  • Neck
  • Tonsil
  • Floor of the mouth

If you have a larger tumour you have external radiotherapy. But your doctor may suggest that at the end of your external treatment, you have a booster dose of interstitial radiotherapy to help shrink the bulkiest part of your tumour.

 

Having interstitial radiotherapy

For this procedure you are under a general anaesthetic. The doctor places a number of hollow, thin tubes directly into your tumour. To make sure they are in the right position you may have an X-ray.

The implants stay in place from a few minutes to a few days. If the implants are a booster treatment after external radiotherapy they may stay in for 2 days. If the implants are your only treatment they may stay in for between 3 to 5 days.

For the actual treatment, the radiographers connect the tubes to a brachytherapy machine. This machine contains a radioactive metal ball which travels out of the machine, into the tubes and releases high doses of radiotherapy directly into your tumour. You can have up to two treatments a day. 

They do not last long but you have to be alone when you have the treatment. The radiographers watch you from outside the room during the treatment, on a closed circuit television screen.

You then have another general anaesthetic and have the tubes taken out. You are likely to feel sore for up to 2 or 3 weeks after you have had the implant removed.

Having implants in your mouth can be uncomfortable. They can make eating and talking difficult. You may need a soft or liquid diet while the implants are in place. Your nurse shows you how to keep your mouth clean by using a mouthwash. A speech and language therapist can help you to communicate as well as you can and make sure that you can swallow well.

 

Safety precautions

If you have internal radiotherapy there are certain safety precautions that you and anyone visiting you will need to take. Your doctor, nurse or radiographer will explain these to you.

 

For more information

Find out about

Radiotherapy

Internal radiotherapy

Information about radioactive implants

Safety precautions

Coping with cancer

For general information and support

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Updated: 14 October 2014