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 
. 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.
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.
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.
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.
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.
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.
Daniel (senior 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.
We then line up the machine based on your tattoo marks.
It's really important that you stay very very still when you're having your treatment. It’s also important to let the radiographers know right at the beginning if you're not comfortable, so they can adjust your position”.
(Radiographer): “Ok, all done we'll be back in a couple of minutes”.
(Daniel): “We leave the room and 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 and hear you while you're having your treatment and 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 then 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”.
Jeff (patient): “They get you from one sitting area to another. And then take you into the room where you undress to the waist and then lie down. And line you up by either moving you or asking you to shuffle a little.
And they check the dimensions and they talk to one another, and they say I'm fine this side, how are you?
Yes fine, ok, stay where you are Jeff, and that was it.
A few little clicks and lights go on and off, and you can see a green laser beam which lines up with certain things on your body….so no, no real noise and no discomfort”.
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.
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.
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.
