Radiation therapy for nasal cavity and paranasal sinus cancer

Radiation therapy uses high-energy rays or particles to destroy cancer cells. Most people with nasal cavity and paranasal sinus cancer have radiation therapy. Your healthcare team will consider your personal needs to plan the type and amount of radiation, and when and how it is given. You may also receive other treatments.

Radiation therapy is often combined with chemotherapy to treat nasal cavity and paranasal sinus cancer. This is called chemoradiation. The chemotherapy drug most often used is cisplatin. The 2 treatments are given during the same time period.

Radiation therapy is given for different reasons. You may have radiation therapy or chemoradiation to:

• destroy the cancer cells in the body
• shrink a tumour before other treatments such as surgery or chemotherapy (called neoadjuvant therapy)
• destroy cancer cells left behind after surgery or chemotherapy to reduce the risk that the cancer will come back (recur) (called adjuvant therapy)
• relieve pain or control the symptoms of advanced nasal cavity and paranasal sinus cancer (called palliative therapy)
• destroy cancer cells that may have spread to the lymph nodes in the neck

Talk to your healthcare team to find out what you need to do before radiation therapy begins. They may discuss the following, depending on your personal needs.

Visiting your dentist. Radiation therapy to the head and neck can affect your dental health. Most people have a thorough dental exam before radiation therapy begins to prevent dental problems. The dentist will remove unhealthy teeth and develop a dental care plan for you to follow after radiation therapy.

Meeting with a registered dietitian. Radiation therapy to the head and neck can make swallowing difficult and painful. A registered dietitian will meet with you and assess your nutrition status. You may need to get a feeding tube placed if you may not be able to meet your nutrition needs during and after radiation therapy treatment. Find out more about tube feeding.

Quitting smoking. Smoking during treatment may make the radiation therapy less effective. People who smoke tobacco may also have worse side effects from radiation therapy. If you smoke, get help to quit smoking before you start radiation therapy.

The following types of radiation therapy are most commonly used to treat nasal cavity and paranasal sinus cancer.

During external radiation therapy (also called external beam radiation therapy), a machine directs radiation through the skin to the tumour and some of the tissue around it. You may also have radiation to the neck if your doctor thinks that the cancer may have spread to the lymph nodes in the neck (called cervical lymph nodes). Small tumours in the nasal cavity can be treated successfully by radiation therapy alone. It is often done instead of surgery because radiation therapy does not change the look of your face as much.

Before you start external radiation, you will be fitted with a custom immobilization mask. An immobilization mask is often used when radiation therapy is given to the head and neck. The mask makes sure that you don't move during treatment and that radiation is directed at exactly the same place each time. You need to wear it during treatment planning and all radiation treatments.

External radiation therapy is usually given once each day for 5 to 7 weeks. If it is given after surgery, radiation therapy usually starts 4 to 6 weeks after you have surgery. The healthcare team will try to protect healthy tissue in the area from radiation as much as possible.

Some people with nasal cavity and paranasal sinus cancer may benefit from smaller doses of radiation given more frequently (called hyperfractionation) or having the same total dose in a shorter amount of time (called accelerated fractionation).

The following are newer ways to giving external radiation therapy. They may be used to treat nasal cavity and paranasal sinus cancer.

Intensity-modulated radiation therapy (IMRT) is a type of external radiation therapy called conformal radiation therapy. It uses a special device to shape and aim many radiation beams at the tumour from different angles. The strength (intensity) of the radiation beams can also be changed. This reduces the amount of radiation that reaches sensitive areas of the head and neck, while allowing a higher dose to be given to the tumour and causing less side effects. IMRT may be a treatment option for large tumours in the nasal cavity or paranasal sinuses and tumours that have grown into the base of the skull.

Proton therapy uses protons (positively charged particles) to treat cancer. It may also be called proton beam therapy. It uses proton beams instead of x-ray beams. Protons release more energy after reaching a certain distance and then stop, while x-ray beams release energy before and after they hit their target. So protons cause less damage to tissues they pass through before reaching their target. Proton therapy causes the least amount of damage to nearby healthy tissues.

3D conformal radiation therapy (3D-CRT) delivers radiation to the tumour from different directions. The radiation beams are all the same strength.

Internal radiation therapy places radioactive materials in the body. Larger doses of radiation can be given with internal radiation therapy than with external radiation therapy.

Brachytherapy is a type of internal radiation therapy. It uses a radioactive material called a radioactive isotope. It is placed right into the tumour or in the area where the tumour was removed. The radiation kills the cancer cells over time.

Brachytherapy may be used, with or without external radiation therapy, to treat early-stage tumours in the nasal cavity or the nasal vestibule. Interstitial brachytherapy is usually given for these tumours. It uses implants, which are thin needles containing a radioactive substance, placed directly into the tumour and surrounding tissue.

Side effects can happen with any type of treatment for nasal cavity and paranasal sinus cancer, but everyone's experience is different. Some people have many side effects. Other people have only a few side effects.

During radiation therapy, the healthcare team protects healthy cells in the treatment area as much as possible. But damage to healthy cells can happen and may cause side effects. If you develop side effects, they can happen any time during, immediately after or a few days or weeks after radiation therapy. Sometimes late side effects develop months or years after radiation therapy. Most side effects go away on their own or can be treated, but some side effects may last a long time or become permanent.

Side effects of radiation therapy will depend mainly on the size of the area being treated, the specific area or organs being treated, the total dose of radiation, the treatment schedule and whether or not chemotherapy is given during the same time period as radiation therapy (called chemoradiation). Side effects tend to be worse with chemoradiation. Some common side effects of radiation therapy used for nasal cavity and paranasal sinus cancer are:

• dry mouth
• fatigue
• skin problems
• problems with the nose and sinuses, such as thick mucus or narrowing of the nasal passages from scar tissue
• sore mouth and throat
• dry eyes
• swallowing problems
• vision changes
• taste changes
• changes to sense of smell
• loss of appetite
• nausea and vomiting
• hearing loss
• somnolence syndrome
• damage to the thyroid gland
• osteoradionecrosis
• difficulty opening the jaw (called trismus)
• damage to the pituitary gland
• swelling, called lymphedema

Tell your healthcare team if you have these side effects or others you think might be from radiation therapy. The sooner you tell them of any problems, the sooner they can suggest ways to help you deal with them.

Find out more about radiation therapy and side effects of radiation therapy. To make the decisions that are right for you, ask your healthcare team questions about radiation therapy.