Radiotherapy to the head and neck for children
This page has been produced to provide information about radiotherapy to the head and neck area and aims to answer some of the questions often asked by patients and their carers.
We hope you will find this helpful.
There are several different tumours that may affect the head and neck.
For some we give radiotherapy alone and in others chemotherapy and surgery may also be used. We give radiotherapy because the disease may come back if we do not. The treatment has to be planned with great care and it is successful for many but unfortunately not all patients.
The total radiation dose has to be spread out to make the individual treatments safe. We give treatment every day for between four and seven weeks (usually excluding weekends and bank holidays). At each session the patient spends about ten minutes in the treatment room but most of this time is spent getting him/her into the right position.
Radiotherapy does not hurt, the machine does not touch the patient and it is rather like having an ordinary x-ray. We have to treat the whole area accurately, which means that the patient must lie very still, usually on their back. To make this easier, we make a facemask for each patient to help keep them in the correct position. The technicians in the mould room will make this and a separate appointment to attend the mould room will be arranged.
Lying still can be very difficult for some children, particularly young ones, so occasionally we have to use a general anaesthetic. A buzzing noise may be heard when the machine is working.
There are always side effects to radiotherapy. We can relieve most of them but sometimes not completely. Some of the side effects happen immediately, some of them happen soon after we finish treatment and some take a longer time to show.
The exact side effects will depend on where the tumour is and how much treatment is needed, so not all the side effects mentioned will necessarily happen.
A discomfort in the gullet (oesophagus) or throat may occur when eating or drinking. This can be treated and will go away within a couple of weeks of finishing treatment.
Nausea and occasionally vomiting may occur but it can usually be well controlled with anti-sickness drugs.
If the mouth is treated, the saliva can dry up and taste can change. In addition the lining of the mouth may become sore and ulcerated. This can make eating difficult and the appetite may be affected. We can help by advising on suitable painkillers and mouthwashes. It is important to drink plenty of fluids especially when eating and to avoid hot or spicy food. Our dietician will advise on build up drinks and supplements if required. Alcohol and smoking should be avoided as they make any soreness worse.
The skin in the treated area may get pink and sore during the course of treatment. It is best to avoid soap, wash with warm water only and gently dab the area dry. We will advise on any additional treatment that will help. Any skin reaction should settle down within four to six weeks.
If there is hair in the area being treated then this will fall out. It starts to fall out after about two weeks of treatment and is more or less gone by the end. It usually starts to grow back about three months after treatment though it might be thinner than before.
Side-effects after completing treatment
Long-term side effects
These are the hardest to predict and unfortunately when they do happen, they are permanent.
If the salivary glands are treated, the mouth may be dry and teeth will be more at risk of tooth decay. It is important that teeth are cleaned regularly and that regular check- ups are performed. The dentist should be informed that the patient is having a course of radiotherapy.
Salivary glands may produce less saliva, which will lead to a dry mouth and a need to drink more fluid than normal especially when eating. Food and drinks may taste different to before treatment.
The radiation may affect the growth of the neck bones in the radiation area. There might be some under development of these, but this is unlikely to affect overall height. Radiation will affect the development of bone and muscles in the area treated. In a child who is still growing this may mean that the treated area will be smaller and so look different. In particular, if only one side of the neck or face is treated than the two sides may look different. Surgery may help to improve the appearance but this is usually only considered after growth is complete.
The thyroid gland (in the low neck) can also be affected by radiation. It may become underactive or occasionally overactive even many years after treatment. Both these conditions are detectable on blood tests and can be treated.
For some tumours we have to include the pituitary gland (at the base of the brain) in the treatment. This may mean that it does not produce as much growth hormone as usual. Growth hormone injections can correct this and there is rarely any effect on final height. The pituitary gland also controls development and radiotherapy in children may make puberty start earlier. Endocrinologists (doctors specialising in hormones) will help deal with any problems and advise on the replacement of hormones normally produced by the pituitary gland.
We are finding that, very rarely, children who have had treatment for one tumour can develop another type of tumour some years later.
During follow-up we will be looking out for all of these problems.
Leaflet to download
You can also download the information on this page as a PDF leaflet: