Having radiotherapy for nasal and sinus cancer

This treatment directs a high dose of radiation to the area of the tumour from outside the body. You have your treatment in the hospital radiotherapy department. This means going to the hospital for treatment once a day, from Monday to Friday, with a break at the weekends. You should not have unnecessary gaps in your treatment. The length of the course of treatment varies, depending on the type and size of the cancer and the aim of the treatment. But it is usually for between 4 and 7 weeks.

Your doctor will make sure that the whole of the area with cancer is treated, as well as 1 to 2 centimetres around it. This is to make sure they don’t miss any stray cancer cells. Doctors call these stray cells 'microscopic spread'. A scan is unable to pick them up because they are so small. But if they are left, they could cause your cancer to come back.

If you smoke you will have been advised by your doctor to give up. But if you have not yet given up this is a very good time to stop as you should not smoke whilst you are having your course of radiotherapy. There is more about giving up smoking on the Cancer Research UK News & Resources website.

If you have radiotherapy to any area of your face and neck, you will usually need to wear a treatment mask, also called a cast, mould or shell. This keeps your head and neck very still during your treatment, and makes sure that you are in the same position every time you have radiotherapy. This helps to make sure that the radiation only goes to the exact area that needs treating. The mask will fit over your lower jaw and neck. The radiographer attaches it to the radiotherapy couch each time you are treated. Below is a picture of a mask.

You have your mask made during your first planning appointment. Before you have anything done, the staff will explain what is going to happen. The mould room technician will make your mask individually for you in the mould room. It should feel comfortable and secure when you wear it. Having the mask made won't hurt. But it may feel a bit strange to have someone working so near to your face.

You will have a dental impression made with gel. The technician will put the gel into your mouth and take an impression of your teeth. This takes between 5 and 10 minutes. The technician will also make an impression of your lower jaw and neck. The whole visit takes about 30 minutes.

Masks are made from either a thin sheet of clear plastic or various materials which mould into shape easily when they are heated up. The technician will cut holes in the mask for your nose and mouth so that you can breathe comfortably.

Radiotherapy treatment is carefully planned. You may need to have a CT scan done as part of your radiotherapy planning. This is so the specialist has a view of the tumour from all sides (3 dimensionally or 3D). During your planning appointment, you lie under a large machine called a simulator. Using information from the CT scan or X-rays the simulator works out exactly where to give the treatment, in order to

• Hit all of the tumour and a border of tissue around it, where there are most likely to be cancer cells
• Avoid as much of the surrounding healthy body tissue as possible

You may hear your specialist call this ‘conformal radiotherapy’. This just means that the radiation beams are shaped to fit (or ‘conform to’) the shape of the tumour.

Each treatment only takes a few minutes. The radiographer will help position you on the couch and make sure your mask feels comfortable. You will be left alone for the minute or two the machine is switched on. The staff will be able to see and hear you through a TV and intercom, so you can call if you need them. The treatment does not hurt - you will not be able to feel it at all. You must lie very still for the few minutes it takes to treat you.

Having external radiotherapy doesn’t make you radioactive. It is perfectly safe to be with other people, including children and pregnant women, throughout your treatment course. 

Below is a picture of a radiotherapy machine.

IMRT is a newer form of radiotherapy where both the beam and the dose within the beam are shaped to match the tumour. This type of radiotherapy treatment is not available everywhere. Radiotherapy where just the beam is shaped is called conformal radiotherapy - the beam conforms to the shape of the cancer. IMRT is a step on from that, as the radiation dose is also altered within the shaped beam, depending on the thickness of the tumour. 

With any type of conformal radiotherapy, less normal tissue is in the way of the radiotherapy beam. So you may have fewer severe side effects such as a dry mouth and sore throat. There is a small risk that this shaped radiotherapy will miss some of the cancer and so may not work so well. Research results are starting to show that IMRT causes less severe long term side effects than conventional radiotherapy. For example, a dry mouth is less severe when doctors are able to lower the dose that the salivary glands receive.

In the main radiotherapy section of CancerHelp UK there is detailed information about

• What radiotherapy involves and
• How your radiotherapy treatment is planned