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What do you need to know?

When you first attend the Spire Specialist Care Centre, a Therapy Radiographer will explain the treatment process and will discuss any possible side effects and their management during and after radiotherapy. We have listed some useful information below, which you may useful and answer some of your questions.

Having Radiotherapy treatment

Your first appointment at the Spire Specialist Care Centre will be for planning purposes. To begin with, the radiographers will make an immobilisation mask (detailed further in this information booklet). The mask helps to ensure your position is replicated for treatment daily. You will then have a CT scan whilst wearing your mask, which will be used to plan your radiotherapy treatment. The Therapy Radiographers will put some marks on the mask. In some cases, you may need an MRI scan to provide additional information for your treatment planning. Following this, your next appointment will be for your first radiotherapy treatment.

Chemotherapy may be given on certain days during your radiotherapy course. Your Clinical Oncologist will discuss this with you and provide written information if this option is applicable to you.

Preparing for treatment

Dental work

Before your first visit you may have been recommended to have an oral care assessment with your own or hospital dentist. Any dental work may be difficult during and for a time after treatment, so it is essential that it be completed before the treatment process begins.


 

Feeding tube or PEG (percutaneous endoscopic
gastrostomy)

Some patients may require a feeding tube to be fitted prior to the commencement of radiotherapy. This is used if swallowing becomes difficult. The tube allows liquid feed to move into the stomach bypassing
the throat. It can be hidden under your clothes when not in use. Your doctor will discuss this with you if they feel it may be necessary for you to have a feeding tube.


 

The immobilisation shell (mask)

The purpose of the immobilisation shell is to ensure the head and neck area is in the same position every time you are treated and to help to keep you still while you are having the treatment. Any marks that
are used to help get you into the correct position for treatment will be placed on the mask and not on your skin. The mask is made with you lying in the treatment position (usually on your back, with your arms by your side). A support is placed under your head that tilts your head to the correct position.


A plastic mesh material will be warmed and softened in water until it is flexible. The radiographers will place this mesh over your face and head, gently moulding it around you. You will need to lie still for a few minutes until it has set and can be lifted off. You will be able to breathe normally and will be able to hear the radiographers throughout the procedure.
The mask should be a snug fit to ensure that your position is accurate
and reproducible on a daily basis. If you wear dentures, you may be asked to remove them before the mask is made and subsequently for each radiotherapy treatment.

Treatment

The Therapy Radiographers will ask you to lie on the couch in the same
position you were in at the CT planning appointment. They will use the marks on your immobilisation mask to accurately align you for treatment. When you are in the correct position, the Therapy Radiographers will inform you that they are leaving the room. You will be asked to remain as still as possible and breathe normally. The radiographers will be watching you on closed circuit cameras and can speak to you via an intercom system. The radiotherapy machine will move around you, it will not touch you and there is nothing to feel or see whilst the radiotherapy treatment is taking place. This treatment will not take long.  

You will be given time to discuss any questions or concerns you may have with the Therapy Radiographers before you start the treatment.

Looking after yourself during and after radiotherapy

Skin Care

  • Radiotherapy may cause a change to your skin in the treatment area. This normally occurs 10-12 days after starting the radiotherapy treatment. Everyone is different in how they react
    to the radiotherapy treatment and varies from person to person.
    • Skin reactions are a common side effect when having the head and neck area treated.
  • The skin reaction commonly caused by radiotherapy is called erythema. This can be noticed as a pink/reddening/discolouration of the skin. Sometimes it can feel dry and itchy and in some cases
    the skin may peel and break.
  • Your skin will be monitored daily by your team of radiographers. They will advise you regarding creams and dressings you may need over the course of treatment.

Moisturising

  • Some skin care products contain perfumes and fragrances that will
    irritate your skin during radiotherapy.
  • The radiographers will give you cream that can be used during the
    radiotherapy treatment. We advise you to apply this cream sparingly over the treatment area 2-3 times a day from the
    start of the radiotherapy treatment.
  • You can come to the radiotherapy with the cream on your skin; this will not affect your treatment.

Smoking and drinking alcohol

  • If you are a smoker it is very important that you stop smoking, as it limits the effectiveness of the radiotherapy.
  • Smoking also makes the side effects much worse, slowing down the healing process after your treatment has finished.
  • Alcohol - especially spirits will irritate the areas of your mouth and/or throat affected by your treatment. It is preferable to avoid alcohol or mouthwashes containing alcohol.

Washing

  • You are advised to bath or shower as normal during the radiotherapy treatment course. It is fine to wash the area being treated but wash with tepid water as very hot or cold water may
    irritate your skin.
  • Use a mild unperfumed soap. Simple or baby soap are recommended. The radiographers are happy to advise you
    on suitability of skin care products if you have other preferences.
  • If you wish to have a bath during treatment it is best to avoid bubble bath products as this may irritate your skin.
  • When drying your skin after washing, it is advised to pat the area dry.
  • We do not recommend using talcum
    powder in the treatment area.

Side effects

Side effects occur because of the effect of radiation on normal cells in the treatment volume. They can vary from individual to individual and most are temporary as normal tissue will start to recover when the radiotherapy has finished.

Short term side effects

Skin

  • Gradually over the course of treatment, the skin in the treated area will become red, itchy and sometimes sore. Occasionally, the skin will blister, peel and may become moist.
  • Your skin will be monitored daily by your team of radiographers. They will advise you regarding creams and dressings you may need over the course of treatment.

 

Soreness of the throat and mouth or difficulty swallowing

  • As treatment progresses, you may find that it becomes painful or difficult to swallow.
  • The radiographers can provide you with appropriate pain relief and mouth washes that contain a local anaesthetic.
  • The pain will gradually settle after treatment has finished but can continue for many weeks after completion of radiotherapy.

 

Dry mouth

  • If the salivary glands are being treated, the production of saliva will be reduced. This makes the mouth dry and chewing and swallowing may become difficult. 
  • Artificial saliva can be administered to help maintain moisture levels in the mouth.
  • Plaque will become thicker and stick more to the teeth and dentures, which can increase the risk of tooth decay and gum disease.
  • It is essential that you maintain a good level of oral hygiene by brushing your teeth after meals and before bed.
  • Use a soft toothbrush and fluoride toothpaste and mouthwash for
    sensitive teeth.
  • Salt water mouthwashes should be used regularly, but you may be advised to use an antiseptic mouthwash.
  • The review radiographers will do weekly oral care assessments and will advise you on what is best for you to use.

 

Diet

  • As treatment progresses, you may find it increasingly difficult to eat the foods that you are used to. 
  • You may lose your taste or it may change. These changes can persist for many months but should improve in most patients.
  • A softer or more liquid diet and eating smaller amounts more regularly may be easier to cope with. 
  • Avoid hot/spicy food and let your food cool down before you eat.
  • It is advisable to increase your fluid intake while having radiotherapy treatment. Spirits should be avoided as they are an irritant.
  • You will be referred to a dietitian who will monitor your diet and weight over the course of your treatment and be able to provide you with support and advice.

 

Hair loss

  • If you have any hair within the area that is being treated you may lose it.
  • It may take a few months to regrow or the hair loss maybe permanent depending on your individual treatment plan. Your consultant will discuss this with you prior to starting radiotherapy
    treatment.
  • Sometimes when the hair regrows, it may initially be a slightly different colour or texture.

 

Hoarseness

  • If your larynx (voice box) is involved in the treatment area, as treatment progresses, you may find that your voice becomes hoarse and sometimes there may be no voice at all.
  • The voice should usually return after treatment has been completed – it can sometimes have a slightly different tone.

 

Nausea

  • Radiotherapy to the head and neck area does not generally cause nausea or vomiting.
  • Chemotherapy can make patients feel sick and can contribute to nausea whilst having radiotherapy.
  • Please let the radiographers looking after you know if you are struggling with nausea and vomiting and they will provide you with medication to help alleviate it.

Fatigue

  • As the treatment progresses, you may become tired. It is important to listen to your body and rest when necessary.
    Increasing fluid intake can also help to combat fatigue.

 

 

Long term side effects

Dental caries

  • Dental caries may occur three to twelve months following a course of radiotherapy due to changes in saliva production. It is important to maintain a good standard of oral hygiene.

Osteoradionecrosis

  • Very rarely bone necrosis can occur due to radiation damage to the jaw bones.

Trismus

  • The muscles surrounding the jaw can become tight and contracted making it difficult to fully open the mouth. You will regularly see a Speech and Language Therapist whilst having radiotherapy treatment, who will provide you with exercises to help combat trismus.

 

Oesophageal Stenosis (narrowing of the food pipe)

  • The upper part of the oesophagus can become narrower as a result of radiotherapy, making it harder to swallow some foods 
  • Fibrosis can happen if scar tissue in the throat makes the swallowing muscles tight and hard.
  • Please contact your Clinical Oncologist or Speech and Language Therapist if you experience any of these symptoms