Chemoradiotherapy means having chemotherapy and radiotherapy treatment together.
Chemotherapy uses anti cancer (cytotoxic) drugs to destroy cancer cells. The drugs circulate throughout the body in the bloodstream.
Radiotherapy uses high energy x-rays to treat cancer cells.
When do you have it?
You might have chemoradiotherapy if you have a locally advanced laryngeal cancer (stage T3 or T4).
Your doctor might suggest this treatment to try and cure your cancer instead of having surgery to remove your larynx. An advantage of chemoradiotherapy is that you might still be able to speak afterwards.
But you might need surgery if there are still signs of your cancer after chemoradiotherapy. Or if your cancer comes back later.
Chemoradiotherapy can be difficult to cope with. You will have tests to find if you are fit enough. If you aren't you might be able to have surgery to remove the cancer followed by radiotherapy.
You usually have treatment in the chemotherapy day unit or you might need to stay in hospital for a day or more.
Clare Disney (nurse): Hello, my name is Clare and this is a cancer day unit.
So when you arrive and you’ve reported into with the receptionist, one of the nurses will call you through when your treatment is ready, sit you down and go through all the treatment with you.
Morning, Iris, my name is Clare. I am the nurse who is going to be looking after you today. We’re going to start by putting a cannula in the back of your hand and giving you some anti sickness medication. And then I am going to come back to you and talk through the chemotherapy with you and the possible side effects you may experience throughout your treatment. Is that okay?
Before you have each treatment, you’ll need to have a blood test to check your bloods are okay. And you’ll also be reviewed by one of the doctors to make sure you’re fit and well for your treatment. Sometimes you’ll have the blood test taken on the day of your treatment; other times you’ll have it the day before your treatment when you see the doctor.
Each chemotherapy is made up for each individual patient, depending on the type of cancer they have and where it is and depending their height, weight and blood results.
So, depending on where your cancer is some people have their chemotherapy drug, their cancer drug by drip, some will have an injection and other people will have tablets.
So, Iris, your chemotherapy is going to be given to you in what we call cycles and the cycles are given every three weeks for a period of six cycles. So, you will be coming in for approximately five months for your chemotherapy.
Depending on where your cancer is and what type of cancer you have will be dependent on how often you come in for treatment. An example of a treatment cycle would be for you to come in on Day 1, Day 8 and Day 15 then to have a week’s break before you come back again for Day 1 treatment.
Depending on the type of treatment that you are having, we will also give you some anti sickness tablets to take alongside your chemotherapy and also some drugs to prevent any reactions if that’s appropriate.
All chemotherapy is given over different time periods, so it’s best to check with your nurse about how long you are likely to be in the unit for. This can range from anything up to an hour to an all day treatment slot, so please be prepared to bring along some bits to keep you occupied books and music.
So, before you go home it’s important to make sure you have got the tablets you need to go home with your anti sickness medications and any other symptom control tablets that you may require. Also, to make sure that you’ve got the telephone numbers for the oncology unit to phone if you have a temperature or you are experiencing any other symptoms at home that you need to ask advice about.
So, please make sure when you leave the unit that you’ve got all the information you require and if you’ve got any questions at all don’t hesitate to ask the nurse, who will be able to answer them for you.
Before your next cycle of treatment you will come in and see the doctor in the clinic room. You’ll have a blood test and an examination to make sure you are fit and well for treatment. You will then come back the following day or later on that week for treatment.
When you have chemoradiotherapy, you might have any of these chemotherapy drugs:
- cisplatin and fluorouracil (5FU) together
- taxol or taxotere
You usually have these drugs as a drip into your vein (intravenously).
Into your bloodstream
A nurse puts a small tube into one of your veins and connects it to the drip or you might need a central line. This is a long plastic tube that gives the drug into a large vein, either in your chest or in your arm. It stays in while you’re having treatment, which might be for a few weeks.
You might also have some of these treatments as part of a clinical trial.
Planning your treatment
Before you begin treatment, the radiotherapy team works out how much radiation you need. They divide it into a number of smaller treatments. They call each treatment a fraction.
The radiographers might make small marks on your skin in the treatment area and you usually have a mask made.
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.
It can take a few days or up to 3 weeks before you start treatment.
You lie under a large machine to have radiotherapy.
You have blood tests before and during your treatment. They check your levels of blood cells and other substances in the blood. They also check how well your liver and kidneys are working.
You will probably have some side effects from your treatment. These are the same kinds of side effects you would get from radiotherapy or chemotherapy alone. But when you have both treatments together some of the side effects can be more severe. It also depends on the type of chemotherapy you have.
The side effects gradually get worse during the treatment. They can continue to get worse after your treatment ends. But most of the effects begin to improve after 1 or 2 weeks.
Below are 2 of the possible side effects of chemoradiotherapy.
Sore mouth and throat
Your mouth and throat might get sore. It may be painful to swallow drinks or food. You will have mouth washes to keep your mouth healthy.
You can have painkillers to reduce the soreness. Take them half an hour before meals to make eating easier.
You are likely to get a very sore mouth and throat. You might need strong painkillers such as morphine.
Morphine is often used as the dose can be easily adjusted to your needs.
During and after treatment, you might have a feeling of a lump in the throat when you swallow. This can make it difficult to swallow solid foods.
This problem is often at its worst about 10 days to 2 weeks after you finish treatment.
Tips for eating and drinking
- Drink about 3 litres of water a day while having treatment.
- Eat soft foods.
- Eat slowly and avoid eating late in the day.
- Drink plenty during and after meals to soften your food.
- Eat small amounts often rather than big meals.
- Try different foods to find out which are easiest to swallow.
- You can have high calorie drinks to boost your calorie intake if you need them.
You might need to have liquid food through a tube into your nose or stomach if you can’t eat enough. This is called tube feeding.
There is further information about side effects in the chemotherapy and radiotherapy sections.
If you smoke your doctor will advise you to stop. Smoking during treatment can make the side effects much worse.