About radiotherapy for salivary gland cancer

Radiotherapy uses high energy X-rays to kill cancer cells. You can't feel radiotherapy when you have it. But a course of radiotherapy treatment over a few weeks has some side effects.

You may have radiotherapy on its own or in combination with surgery.

You will have radiotherapy after surgery if your cancer was a high grade cancer or it had spread to the lymph nodes. The radiotherapy lowers the chance of the cancer coming back.

You may have radiotherapy as your main treatment for the following reasons

• Your cancer is in a position that makes it too difficult to remove
• Your cancer is too large to remove with an operation
• You can’t have surgery because of other health problems
• To control symptoms of advanced cancer, such as pain

For salivary gland cancer you have radiotherapy from a machine that directs the radiation at the area of cancer. If you are having treatment after surgery you usually have the radiotherapy daily, from Monday to Friday, for 4 to 6½ weeks.

If you are having radiotherapy on its own, the number of treatments you have may vary, depending on your needs. Your doctor will tell you how many treatments you will need before you start treatment.

If you have an advanced cancer and are having radiotherapy to ease symptoms from the tumour, the treatment is usually for 4 weeks.

Before you start treatment you will usually need to have a treatment mask made. This is also called a mould or cast or shell. It helps to keep your head still during treatment. It also makes sure the radiation is going to the exact area that needs treating. The mask fits over all or part of your face and neck. The radiographer attaches it to the radiotherapy couch each time you have treatment.

Staff in the mould room make your mask during your first planning appointment. The staff will explain beforehand what is going to happen. The mould room technician makes your mask individually for you. 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. There are different types of masks. Masks are made from either perspex or a plastic mesh.

Perspex mask

The perspex mask usually takes a few days to make. There are a number of steps to making it. First the technician gives you something to cover your hair such as a swimming cap. Then they apply some cool cream to your face. On top of this they put strips of plaster of paris bandages. They leave holes for your nose and mouth so that you will still be able to breathe.

Plaster of paris gets warm while it is setting. This is normal and may feel uncomfortable. The plaster takes about five minutes to set and the technician then removes it. They make a perspex mask from this mould.

The photo below shows a finished Perspex mask ready to be used for treatment. The holes around the edge of the mask are used to fix it to the radiotherapy couch.

You may also have a dental impression made with gel. The technician puts the gel into your mouth and takes 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.

Mesh plastic mask

The other type of mask uses a plastic mesh. The process usually takes around 30 minutes. The technician uses a special kind of plastic that becomes soft and bendy when heated in warm water. They put the softened sheet of mesh over your face and mould it to fit exactly. It feels a little like having a warm flannel on your face. You can still breathe easily because the plastic is full of holes.

Once the mesh has moulded and become hard (which takes a few minutes) the technician takes it off. The mask is then ready to be used when you have your treatment.

The photo shows the plastic mesh mask ready to be used

Doctors plan radiotherapy treatment very carefully. You may need to have a CT scan as part of your radiotherapy planning. The CT scan shows the specialist the tumour from all sides (in 3 dimensions – 3D). During your planning appointment you lie under a large machine called a simulator.

Each treatment only takes a few minutes. The radiographer helps to position you on the couch. They will make sure your mask feels comfortable. They fix it to the radiotherapy couch. This keeps you completely still and in the right position for the treatment. You will be left alone for a minute or two when the machine is switched on. The staff will be able to see and hear you through a CCTV link, so you can call them if you need to.

The treatment itself doesn’t hurt. You will not be able to feel it at all. Having external radiotherapy does not make you radioactive. It is perfectly safe to be with other people, including children, throughout your treatment course.

The main radiotherapy section has detailed information about

• What radiotherapy involves
• Radiotherapy treatment planning

You can also find out more about the possible side effects of radiotherapy for salivary gland cancer in this section.