Radiation Therapy for Laryngeal and Hypopharyngeal Cancers

Studies have shown that people who are treated at centers that treat a lot of head and neck cancers with radiation, tend to live longer. And because of the complicated types of surgeries, along with the need for coordination between cancer specialists to make a complete treatment plan, it’s very important to have a cancer center and radiation oncologist who has experience treating these cancers.

Radiation therapy uses high-energy x-rays or particles to kill cancer cells. It can be used in many ways to treat laryngeal and hypopharyngeal cancers:

• As the main (primary) treatment for some early-stage laryngeal and hypopharyngeal cancers. If the cancer is small, it can often be destroyed by radiation and surgery isn't needed. This can help to preserve better voice quality.
• For people who are too sick to have surgery.
• After surgery (adjuvant treatment), to try to kill any small areas of cancer (too small to be seen by the naked eye) that might be left behind and help lower the chance the cancer will come back.
• For cancer that comes back after treatment (cancer recurrence).
• To ease symptoms of advanced laryngeal and hypopharyngeal cancer such as pain, bleeding, trouble swallowing, and problems caused when cancer spreads to the lungs or bones. (This is called palliative or supportive care.)

Many times, for advanced laryngeal and hypopharyngeal cancers, chemotherapy is given at the same time as the radiation. This combination, called chemoradiation, often works better than radiation alone, but it also has more side effects.

Radiation to this part of your body can cause problems to your teeth and gums, so it's important to see a dentist before starting treatment. A dentist can make sure your mouth is healthy before treatment. They might recommend that certain bad teeth be removed before you start radiation because this can increase your chance of infection during treatment. During and after treatment your dentist can help check for and treat any problems that may come up, such as infection or tooth and bone damage.

Quit smoking before laryngeal and hypopharyngeal cancer treatment

If you smoke, you should quit. Your cancer might not shrink as well if you smoke during radiation treatment, you might have more side effects, and your benefit from radiation treatment might be less (which can raise your risk of the cancer coming back). Smoking after treatment can also increase the chance of getting another new cancer. Quitting smoking for good (before treatment starts, if possible) is the best way to improve your chances of survival. It is never too late to quit. For help, see How To Quit Using Tobacco.

Types of radiation therapy for laryngeal and hypopharyngeal cancer

The types of radiation therapy that might be used to treat laryngeal and hypopharyngeal cancer are:

• External beam radiation therapy
• Brachytherapy

External beam radiation therapy

The main type of radiation therapy used to treat laryngeal and hypopharyngeal cancer is external beam radiation therapy. External beam radiation therapy (EBRT) focuses radiation from a source outside the body on the cancer.

Before your treatments start, the radiation team will use a CT scan to take careful measurements to determine the correct angles for aiming the radiation beams and the proper dose of radiation. A flexible, but sturdy, head and neck mask made from a plastic mesh might be made to hold your head, neck, and shoulders in the exact same position for each treatment. Some people might feel a bit confined while this mask is on and might need to ask for medicine to help them relax during the treatment. Sometimes, the mask can be adjusted so that it is not too constricting. Your radiation oncologist can discuss the options with you. 

Radiation therapy is much like getting an x-ray, but the radiation is much stronger. The procedure itself doesn't hurt. Each treatment lasts only a few minutes, but the setup time – getting you into place for treatment – usually takes longer.

Standard EBRT for laryngeal and hypopharyngeal cancer is usually given in daily fractions (doses), 5 days a week, for about 7 weeks. Other schedules for radiation that might be used to treat laryngeal or hypopharyngeal cancer include:

• Hyperfractionation radiation: a slightly lower radiation dose is given more than once a day (for example, radiation is given twice a day for 7 weeks)
• Accelerated fractionation radiation: a standard dose of radiation is given each day over a shorter amount of time (5 to 6 weeks) instead of the usual 7 weeks (for example, radiation is given 6 days a week over 5 weeks instead of the standard 5 days a week for 7 weeks)
• Hypofractionation radiation: a slightly higher radiation dose is given each day to lessen the number of treatments (for example, a higher radiation dose is given each day for 6 weeks, not the standard 7 weeks)

There are also more advanced EBRT techniques that help doctors focus the radiation more precisely:

• Three-dimensional conformal radiation therapy (3D-CRT): 3D-CRT uses special computers to map the location of the tumor precisely. Several radiation beams are then shaped and aimed at the tumor from different directions, which makes it less likely to damage normal tissues.
• Intensity modulated radiation therapy (IMRT): IMRT is a form of 3D-CRT. It uses a computer-driven machine that actually moves around the patient as it delivers radiation. Along with shaping the beams and aiming them at the tumor from several angles, the intensity (strength) of the beams can be adjusted to limit the dose reaching nearby normal tissues. This helps the doctor deliver a higher dose to the tumor.

Brachytherapy

Internal radiation therapy, also known as brachytherapy, puts radioactive material right into or near the cancer. It's rarely used to treat laryngeal and hypopharyngeal cancer as first treatment, but might be used if the cancer recurs (comes back).

Side effects of radiation therapy for laryngeal or hypopharyngeal cancer

If you are going to get radiation therapy, it’s important to ask your doctor about the possible side effects, so you know what to expect.

Common side effects depend on where the radiation is aimed and can include:

• Skin problems in the area being treated, ranging from redness to blistering and peeling
• Mouth sores
• Dry mouth
• Worsening of hoarseness
• Trouble swallowing
• Change of taste
• Possible breathing trouble from swelling
• Tiredness
• Hearing problems

Most of these side effects slowly go away when treatment is over. Side effects of radiation tend to be worse if chemotherapy is given at the same time. Tell your doctor about any side effects you have because there are often ways to help.

Mouth sores and problems swallowing

Many people treated with radiation to the neck and throat area have painful sores in the mouth and throat that can make it very hard to eat and drink. This can lead to weight loss and malnutrition. The sores heal with time after the radiation ends, but some people might continue to have problems swallowing long after treatment ends.

Ask your speech pathologist about swallowing exercises you can do to help keep those muscles working and increase your chance of eating normally after treatment.

Dry mouth

Radiation aimed at the head and neck might damage the salivary glands, leading to dry mouth that doesn't get better with time. This can cause discomfort and problems swallowing, and can also lead to tooth decay and damage to the jaw bone. People treated with radiation to the neck and throat must pay close attention to their oral health and see a dentist regularly.

Thyroid problems

Radiation might damage your thyroid gland. Your doctor will order regular blood tests to see how well your thyroid is working. You may need treatment if it's been damaged and not working well.

Lymphedema

Some people treated with radiation therapy might be at risk of developing lymphedema in the head and neck areas that were radiated. These areas can become swollen and firm. This can be worse if the person also had surgery. Sometimes, medicines, physical therapy, or massage therapy might be helpful.

Damage to the carotid artery

A person who has had radiation to the neck area might have an increased risk of stroke many years after treatment. This might be because of health problems that were already present before radiation such as narrowing of the artery or an increase in plaque both of which can decrease blood flow . People who smoke are also at risk. Because of this some doctors might schedule regular ultrasounds for you after treatment, to keep an eye on your arteries.