Chemoradiotherapy for nasopharyngeal cancer

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 radiation, usually x-rays, to destroy cancer cells.

Why you have chemoradiotherapy

Some chemotherapy drugs help to make cancer cells more sensitive to radiotherapy. 

Chemoradiotherapy works better than radiotherapy alone for people whose cancer has grown into the tissue around the nasopharynx, or into nearby lymph nodes Open a glossary item.  So people with stage 3 or 4 nasopharyngeal cancer, or some people with stage 2, usually have chemoradiotherapy.

Chemoradiotherapy can be quite a tough treatment to have. The side effects can be worse than the side effects of radiotherapy or chemotherapy on their own. So you have tests to see if you’re fit enough to have it.

How do you have chemoradiotherapy?

You usually have radiotherapy every day, from Monday to Friday, for about 7 weeks.

You have the chemotherapy drug cisplatin (or sometimes carboplatin) alongside the radiotherapy. You may have the chemotherapy once a week or once every 3 weeks, starting on the first day of radiotherapy.

Occasionally, your doctor may stop your treatment for a short time if the side effects become too difficult. But it can usually start again after a few days of rest.

Chemotherapy

You have the chemotherapy through a drip into your arm or hand. Your nurse puts a small tube (a cannula) into one of your veins and connects the drip to it. They remove the cannula once you have finished the chemotherapy.

Diagram showing a cannula

Or you might have a central line. This is a long plastic tube that gives the drugs into a large vein, either in your chest or through a vein in your arm. It stays in the whole time you’re having the course of treatment.

You usually have chemotherapy in the chemotherapy day unit. You have the radiotherapy once you have finished your chemotherapy drip. On the days you don’t have chemotherapy you go straight to the radiotherapy department.

Radiotherapy

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. This is called radiotherapy planning. You also have a mask made. The radiographers use this to help keep you in the correct position for the treatment.

Photograph of a mesh plastic mask used for radiotherapy for cancer of the head and neck and brain

Radiotherapy machines are very big and could make you feel nervous when you see them for the first time. The machine might be fixed in one position. Or it is able to rotate around your body to give treatment from different directions. The machine doesn't touch you at any point.

Photo of a linear accelerator

The radiotherapy treatment itself is often quite quick, lasting a few minutes. But it may take a little while to get you in the correct position beforehand.

Side effects

You will get some side effects from your treatment. These are the same kinds of side effects you get from radiotherapy or chemotherapy alone. But when you have both treatments together some of the side effects can be more severe.

Everyone is different and the side effects vary from person to person. You might not have all of the effects mentioned by your doctor or radiographer. Side effects depend on the type of chemotherapy you have. They also depend on the radiotherapy treatment area.

The side effects gradually get worse during the treatment. They can continue to get worse after your treatment ends. But most of the side effects begin to improve after 1 or 2 weeks.

Always let your doctor, nurse or radiographer know about any side effects you have so that they can help.

Sore mouth and throat

You are likely to get a very sore mouth and throat. This often starts after about 2 weeks of treatment. You may only manage soft food and liquid supplements. Some people find that their mouth is so sore that it is too difficult to swallow. If this happens, you are likely to need a feeding tube so that you can get enough liquid and calories.

You also have painkillers. You might need a strong painkiller such as morphine to help make your mouth more comfortable.

When you have a very sore mouth and throat, you must be very careful about infection. Try to keep your mouth clean and follow the advice of your nurse and dentist. Contact the hospital at the first sign of infection – particularly a change in temperature, chills, or a cough. You might need to go to the hospital and have antibiotics through a drip.

Dry mouth

A dry mouth can make eating and talking uncomfortable. Your doctor can prescribe artificial moisteners for your mouth if it is a problem for you. People who have a dry mouth often find it helps to sip water regularly and carry a bottle of water with them all the time.

Increased risk of infection

An increased risk of getting an infection is due to a drop in white blood cells. The chemotherapy affects cells, such as white blood cells, in your bone marrow. Symptoms of an infection include a change in temperature, aching muscles, headaches, feeling cold and shivery and generally unwell. You might have other symptoms depending on where the infection is.

Infections can sometimes be life threatening. You should contact your advice line urgently if you think you have an infection. 

Contact your doctor or nurse immediately if you have signs of infection, including a temperature above 37.5C or below 36C, or generally feeling unwell. Infections can make you very unwell very quickly.

Sore skin in the head and neck area

Your skin might go red or darker in the treatment area. You might also get slight redness or darkening on the other side of your head and neck. This is where the radiotherapy beams leave the body. 

The red or darker areas can feel sore. Your radiographers will give you creams to soothe your skin. The soreness usually goes away within 2 to 4 weeks of ending the treatment. But your skin might always be slightly darker in that area.

Tell the radiotherapy staff if you notice any skin changes.

Tiredness and weakness

You might feel tired during your treatment. It tends to get worse as the treatment goes on. You might also feel weak and lack energy. Rest when you need to.

Tiredness can carry on for some weeks after the treatment has ended. But it usually improves gradually.

Various things can help you to reduce tiredness and cope with it, such as exercise. Some research has shown that taking gentle exercise can give you more energy. It's important to balance exercise with resting.

Sticky, thick saliva or phlegm

You may make thick or sticky phlegm, particularly towards the end of your treatment. This can be uncomfortable and make you want to cough. You may need to spit the phlegm into a tissue or bowl as it can be difficult to swallow, particularly if you also have a sore mouth.

Your nurse may give you a nebuliser to help. This is a small machine that changes liquid into a fine mist that you can breathe in through a mask. It helps to loosen the phlegm. It can take a month or two for the changes in your saliva to get better.

Feeling or being sick

Sickness may be worse a few hours after the chemotherapy. Anti sickness injections and tablets can control it. Tell your doctor or nurse if you feel sick. You might need to try different anti sickness medicines to find one that works.

Tips 

  • Avoid eating or preparing food when you feel sick.
  • Avoid hot fried foods, fatty foods or foods with a strong smell.
  • Eat several small meals and snacks each day.
  • Relaxation techniques help control sickness for some people.
  • Ginger can help – try it as crystallised stem ginger, ginger tea or ginger ale.
  • Try fizzy drinks.
  • Sip high calorie drinks if you can’t eat.

Changes to hearing

You might have some hearing loss, especially with high pitched sounds. You may also get ‘ringing’ in your ears (tinnitus). Tell your doctor or nurse if you notice any changes.

Last reviewed: 
18 Feb 2021
Next review due: 
18 Feb 2024
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