Chemoradiotherapy for nasopharyngeal cancer
Chemoradiotherapy means having chemotherapy and radiotherapy treatment together.
Chemotherapy uses anti cancer drugs to destroy cancer cells. These drugs are also called 
. The drugs circulate throughout the body in the bloodstream.
Radiotherapy uses radiation, usually x-rays, to destroy cancer cells.
When do you have chemoradiotherapy for nasopharyngeal cancer?
Chemoradiotherapy is often given to people with stage 3 or 4 nasopharyngeal cancer. Some people with stage 2 nasopharyngeal cancer might have chemoradiotherapy.
You might also have this treatment as part of a clinical trial.
Chemotherapy as part of chemoradiotherapy
The most common chemotherapy is cisplatin. You might have chemotherapy once a week or once every 3 weeks. Usually starting on the first day of radiotherapy.
Chemotherapy before having chemoradiotherapy
If you have nasopharyngeal cancer you might have chemotherapy first followed by chemoradiotherapy.
Radiotherapy
You usually have radiotherapy every day, from Monday to Friday. You might have it for up to 7 weeks.
Chemoradiotherapy for cancer that has come back after treatment (recurrence)
If your cancer comes back after treatment, your doctor might recommend you have surgery and radiotherapy. They might also suggest having chemoradiotherapy afterwards.
This depends on many factors including:
- how big the cancer is
- where the cancer is
- treatment you've had previously
- your general health
Your treatment plan
Your doctor and nurse will discuss your treatment plan with you. They will tell you:
- what treatment you are having
- when you have your treatment
- how long it will last
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.
Where you have chemoradiotherapy?
Chemotherapy
You usually have treatment in the chemotherapy day unit or you might need to stay in hospital for a day or more. On the days you don’t have chemotherapy you go straight to the radiotherapy department.
You might 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.
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
Planning radiotherapy
Before you begin, the radiotherapy team work out how much treatment you need. This is called radiotherapy planning. You also have a mask (shell) made of your head and neck. The radiographers use this to help keep you in the correct position for your treatment.
You have radiotherapy divided into a number of smaller treatments. They call each treatment a fraction.
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 can rotate around your body to give treatment from different directions. The machine doesn't touch you at any point.
Having radiotherapy
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 of chemoradiotherapy for nasopharyngeal cancer
You usually have 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, nurse 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 around 1 or 2 weeks after you finish your treatment.
Always let your doctor, nurse or radiographer know about any side effects you have so that they can help.
Your speech and language therapists also play an important role during your treatment. They will help you with swallowing difficulties (dysphagia) and help you eat and drink safely.
We have listed some of the side effects that are common with chemoradiation. You can read more on our radiotherapy and chemotherapy side effects page.
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.
Most people who have chemoradiotherapy for nasopharyngeal cancer have a sore mouth and throat. It's likely to become increasingly sore during your treatment. This usually continues for a couple of weeks after your treatment and can take several weeks to get better.
The lining inside your mouth may break down (get ulcerated) as you go through your treatment.
Your doctor might prescribe a gel. It forms a protective coating over the inside of your mouth, a bit like a dressing. This can make your mouth less painful and can make it easier to eat and drink. Your doctor or nurse may also suggest using a numbing spray or ointment on sore areas.
Your doctor might also give you painkillers to take regularly. If your throat becomes extremely sore or painful you might need very strong painkillers such as morphine. Some people have these through a pump or skin patches. Your nurse and doctor will tell you more about the painkillers you have and the possible side effects.
Mouth care is important for this type of treatment. Your nurse or radiographer will give you mouthwashes and will tell you how to use them. Try to do this as often as they suggest. It is important to use them to help prevent infection.
At the first sign of infection (particularly high temperature with chills, a sore chest or cough), contact the hospital. You may need treatment, such as antibiotics through a drip.
It is important that you do this without delay. Your immune system may be weakened with this treatment. This means you may not be able to fight an infection in the normal way. Most hospitals give you an emergency card. This will help you to know exactly what to do and who to contact if you develop a temperature or symptoms of an infection while receiving treatment.
Radiotherapy to the nasopharynx can damage the glands that produce your spit (the salivary glands). This can happen within a couple of weeks of starting your treatment. Your doctor might call a dry mouth from lack of saliva xerostomia (pronounced ze-ro-stome-ee-ah).
Some people say they make as much saliva as before, but that it is thicker and stickier. This can make it harder to chew and swallow.
Long term
After the treatment, you might have a permanently dry mouth. This can make eating, swallowing and talking quite uncomfortable.
If you have trouble with a dry mouth, your doctor can prescribe artificial saliva to keep it moist. This will help make you more comfortable.
You are more likely to get an infection or tooth decay if your mouth is dry. So you’ll need to keep an eye on this and have regular check ups with your dentist.
As your course of radiotherapy goes on, you may have difficulty chewing and swallowing. This is because your mouth and throat might be sore.
Speech and language therapists play an important role during your treatment. They will help you with swallowing difficulties (dysphagia) and help you eat and drink safely. They can give information to your family or carer on how to support you with swallowing difficulties.
A dietitian can also give advice on what to eat when you have swallowing problems. This might include having a liquid diet.
You can have these feeds by mouth if you feel you can still swallow. But many people find they need tube feeding to keep their calorie intake up. You can have tube feeding by a:
- nasogastric tube - a tube that goes up in your nose and down into your stomach
- PEG tube - a tube that goes through the skin of your tummy (abdomen) into the stomach
Your nurse shows you and your relatives how to care for these tubes and how to give the feeds.
It is understandable that you might feel upset if you need to have tube feeding. You may feel that another part of normal life has been lost to you. But it is only temporary.
Your health is the most important thing. You will feel a lot better if you are getting the nutrition you need for everyday living. It will also help you recover from your treatment.
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.
You might be breathless and look pale due to a drop in red blood cells. This is called anaemia.
This is due to a drop in the number of platelets in your blood. These blood cells help the blood to clot when we cut ourselves. You may have nosebleeds or bleeding gums after brushing your teeth. Or you may have lots of tiny red spots or bruises on your arms or legs (known as petechiae).
The skin in the area being treated may become sore and itchy. On white skin, the area may look red. On brown or black skin, the treatment area may darken slightly and have a different texture.
Your radiographer will give you advice on washing the area and creams to use to soothe your skin. It is important to get advice from your radiographer before you use anything on your skin in the treatment area.
During your radiotherapy treatment, the skin might break down around the treatment area. Your nurse will use special dressings to cover and protect the area.
It can take around 4 to 6 weeks after treatment or sometimes longer for the skin to get better.
You should avoid removing the hair around the treatment site. This includes shaving, waxing and hair removal creams. Your nurse can help if you have any questions about this.
Tell the radiotherapy team if you notice any skin changes.
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 may help control sickness for some people.
- Sip high calorie drinks if you can’t eat.
Chemoradiotherapy for nasopharyngeal may affect your hearing. You might find it hard to hear soft sounds. Or you might find it hard to tell different sounds apart. It may also make you feel dizzy.
Usually, this is a temporary problem that happens during your treatment and recovery. But occasionally hearing loss or changes can be permanent.
Tell your doctor or nurse if you notice any changes in your hearing.
Getting help
You may feel anxious about the side effects of chemoradiotherapy and this is normal. It can help to talk through any worries you have with your doctor, nurse or radiographer.
You usually have regular checks by your head and neck cancer team during your treatment and for a few weeks afterwards. They can check any side effects you have and give you advice and medicines to help.
Between checks, do speak to your radiographer or nurse if you need help managing any side effects.
Sometimes the side effects of radiotherapy can be particularly severe. If this happens, your doctor may need to stop your treatment to allow you to recover.
