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Treatment of Head and Neck Cancer With Concurrent Radiation Therapy and Chemotherapy

This information will help you prepare for your treatment of head and neck cancer with concurrent radiation therapy and chemotherapy.

You will be getting radiation therapy and chemotherapy at the same time to treat your head and neck cancer. Before your treatment can begin, you will need to see a number of specialists who will all be involved in your care. Many of these specialists will see you during and after your treatment. You also will have some tests, which are discussed below. These tests will be scheduled for you by your healthcare team.

Please note that it may take 6 weeks or longer to complete all of these visits. This should not affect the outcome of your treatment.

Your Treatment Team

  • You may have already met your head and neck surgeon. He or she has discussed with you if surgery can treat your cancer and if you need other treatments. Your surgeon may have done a biopsy (sample of tissue) in the clinic or operating room.
  • Your medical oncologist will plan your chemotherapy treatment.
  • Your radiation oncologist will plan your radiation therapy.
  • Your dentist will check your teeth to prevent complications when you begin radiation therapy. You must see your dentist before your simulation (this procedure is described below). He or she will check your teeth and explain how radiation will affect your mouth. Your dentist may also make you a rubber mouth guard. You will need to wear the guard during your simulation and all of your treatments. You will need to pick it up from your dentist and bring it with you to your simulation.
  • You may need to see a cardiologist to evaluate your heart. Some chemotherapy medications affect the heart. Your cardiologist will work with your medical oncologist to make sure the medications you get are the best ones for you.
  • Your swallowing specialist will check to see how well you can swallow. Swallowing can become difficult during treatment. This specialist will teach you how to keep your swallowing muscles strong.
  • Your dietitian will help you chose the right foods and liquids. You will need foods that are high in nutrition and easy to swallow. He or she will contact you during the first 2 weeks of your treatment
  • You may need to see a gastroenterologist to discuss  placing a feeding tube. A feeding tube is not usually placed before starting treatment, but you may need to have one placed to help you get enough calories during your treatment. It will be taken out when you do not need it any longer. 
  • You may need to meet with a tobacco treatment nurse. If you smoke now, it is important for you to stop. Smoking is a risk factor for head and neck cancer. 

Diagnostic Tests

You will have imaging tests to look at areas inside your body. Your doctor will decide which tests are best for you. Your nurse will give you specific instructions about these tests. The tests you may have are listed below.

  • A computed tomography (CT) scan uses x-rays to create images of the body.
  • Magnetic resonance imaging (MRI) uses magnetic fields and radiowaves to create images of the body.
  • A positron emission tomography (PET) scan uses a radioactive substance called a tracer to look for cancer in the body.

You will also have the 2 following tests:

  • An electrocardiogram (EKG) records the electrical activity of your heart. It is used to help your medical oncologist decide what chemotherapy is best for you.
  • An audiogram (hearing test) is used to help your medical oncologist decide what chemotherapy is best for you.

Treatment Planning

You will have several visits to prepare for your radiation therapy.

Simulation

A simulation is a procedure that helps us plan your treatment. During this visit your radiation therapists will:

  • Make a face mask that you will wear during all of your treatments. This mask holds your head still so that you are in the correct position for all of your treatments.
  • Mark your skin with small, permanent tattoos. These marks help identify the area to be treated. If you’re concerned about receiving tattoos as part of your radiation treatment, talk with your doctor
  • Take a CT scan, PET scan, or MRI of the area to be treated

Treatment planning is done with your radiation oncologist and other specialists. They will determine the dose of radiation that you will receive.

Set-up procedure

A set-up procedure is scheduled 7 to 10 days after your simulation. This is done to make sure everything is set for you to begin treatment. During this procedure, your radiation therapists will position you on the table in the room where you will be treated every day. X-rays will be taken to make sure that your position is correct and that the area being treated is exactly what your radiation oncologist planned.

Important Points

  • You will be given printed schedules for all your appointments. These will include the date, time, and location of each one.
  • You may see your doctors more than once before your treatment begins.
  • You may need other appointments that are not listed here. Your doctor or nurse will explain these to you.