Internal radiotherapy for mouth cancer

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

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

• It reduces physical disfigurement 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 implants are sometimes used to treat head and neck cancers. They are put into the cancer and surrounding tissues. This is called interstitial radiotherapy.

Interstitial radiotherapy 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 will 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.

If you have interstitial radiotherapy, you have radioactive wires, tubes or seeds placed directly into your tumour. You have them put in while you are under general anaesthetic. To make sure they are in the right position you may have an X-ray. The implants stay in place for anything 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 5 and 7days.

While the implants are in place you receive high doses of radiotherapy directly into your tumour. You will have a private room so that other people are not exposed to the radiation. You then have another general anaesthetic and have the implant taken out. You are likely to feel sore for up to two or three weeks after you have had the implant removed.

Some implants (made of radioactive iodine or gold) are left in place permanently. This is nothing to worry about as these implants are made of small seeds. The amount of radiation is very small and can only travel a very short distance. So the tumour gets nearly all the radiation dose, with very little effect on the surrounding tissues and organs. It is not a risk to you or anyone around you. Wire implants are always 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 will show you how to keep your mouth clean by using a mouthwash. A speech and language therapist will help you to communicate as well as you can and make sure that you can swallow well. 

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. There is detailed information about radioactive implants and particularly about the safety precautions in the radiotherapy section.