Laryngeal Cancer

Radiation therapy

The most common radiation therapy treatment for laryngeal cancer is called external beam radiation.  This type of radiation therapy applies radiation from outside the body.
Radiation therapy can be used in both the early and advanced stages of laryngeal cancer in the following ways:
Small field  This is frequently used in the definitive treatment (curative) of early (stage I or II) laryngeal cancer in an outpatient setting. This is when radiation therapy is targeted at the larynx alone. Treatments are usually given daily, for a period of 7 weeks.
Definitive  This is a curative treatment option for patients with advanced stage laryngeal cancer. The aim of the therapy is to preserve the larynx and its function. It is another option to removing the voice box (total laryngectomy). Radiation therapy comprehensively treats the cancer of the voice box, its surrounding region, and the lymph nodes at both sides of the neck. Radiation therapy is typically delivered daily (but not on weekends) for 7 weeks and can be given as:
  • definitive radiation therapy alone; or

  • definitive radiation therapy with concurrent chemotherapy (adding chemotherapy to radiation therapy (chemoradiation) to make it more effective).

Adjuvant This is given after the surgical removal of the voice box and the lymph nodes (on both or either sides of the neck). It is used as an additional treatment to kill cancer cells that may not have been removed during surgery. It usually starts about 4 weeks after surgery to allow recovery from surgery. Radiation therapy treatment usually lasts for about 6 weeks. Sometimes chemotherapy is added to the adjuvant radiation therapy (chemoradiation) to make it more effective.
Palliative  In cases where a cure is not possible, radiation therapy is used to relieve symptoms of advanced laryngeal cancer. Symptoms that may require palliative radiation therapy include pain, bleeding, breathing and swallowing difficulties. 

How do I prepare for radiation therapy? 

You will meet with many members of the cancer care team, who will help you learn how to look after yourself through radiation therapy, recovery and long term follow-up. They will also talk to you about side effects and how to manage them. It may be helpful to write down questions as they come up, so you can ask anyone in your cancer care team when you see them.

 

Radiation therapy mask-making and simulation 

  • Radiation therapy is a precise treatment. In order to make sure, that the cancer is covered by the treatment, you will need to be very still during the treatment, usually for about five minutes. A radiation therapy mask that is made to fit perfectly to your shape, will be put on you during each treatment to help the machine target where the cancer is.
  • You will have a planning CT scan (and sometimes other scans) with the mask on. Your radiation oncologist and radiation therapists will use these scans with all your other clinical information to develop a radiation therapy plan just for you (a personalised plan). Your plan will be checked by the radiation therapy and radiation oncology physics team before it is ready to be used for your treatment. This whole process can take approximately 2-3 weeks.
 

Teeth and mouth care

If you are having radiation therapy for advanced stage laryngeal cancer, dental extraction may be needed to remove any broken or infected teeth before radiation therapy. It is important to take out any broken or infected teeth before radiation therapy. Taking out unhealthy teeth after radiation therapy can cause problems with the jaw bone.

 

 

Diet, nutrition and the role of your dietitian

Your cancer and its treatment can make it hard to eat and drink. Your doctor will recommend you see a dietitian to maximise your nutrition during treatment as well as while you are recovering. Sometime feeding tubes may be recommended depending on the area being treated and the dose of radiation therapy.
There are two common types of feeding tubes: 

  • Gastrostomy tube (sometimes called a PEG tube): this type of tube is inserted through your abdominal wall into your stomach, with part of the tube staying outside the stomach.  A syringe can be attached to the tube to give you food this way if needed. The tube is inserted using a camera through the mouth into the stomach (gastroscopy) or using a CT scanner to guide insertion directly through the skin. If a PEG tube is needed, your doctor will organise this before starting your radiation therapy

  • Nasogastric tube: this type of tube goes through the nose down into the stomach and is usually used for short periods (days or weeks). A nasogastric tube can be inserted at any time (before, during or after treatment).

 
 

Speech, voice and swallowing
 

Your cancer and its treatment can make swallowing and speech difficult. Your doctor will recommend you see a speech pathologist, who can help you with ways to manage swallowing and communication difficulties, during and after treatment. Your speech pathologist will also help with your voice rehabilitation during and after treatment. 

 

 

There are many other aspects of supportive care that are available, ask your doctor if you have any specific needs.

Side effects

The side-effects of radiation therapy start around two weeks into treatment and progress through treatment to peak in the last week or just after treatment ends. The side effects start to improve 2-3 weeks after the end of treatment.

Side effects associated with radiation therapy depend on:
  • the dose of radiation therapy

  • the area being treated

  • whether or not chemotherapy is added to the radiation.

Each person responds to radiation therapy differently. Some people may experience a few side effects while others may not experience any at all. The following are some common side effects of radiation therapy.
  • tiredness

  • hoarse voice

  • skin irritation in the treated area e.g. redness, dryness and itching, weeping skin, scaling or sometimes skin breakdown (sores)

  • pain on swallowing or difficulty with swallowing

  • irritation in the throat progressing to sore throat requiring pain killers

  • dry mouth and throat (with advanced stage laryngeal cancer treatment).

Most side effects are short lived and may go away within 4–6 weeks of finishing radiation therapy. Some side effects may last for months after you finish radiation therapy and some may be permanent.

Uncommon side effects of radiation therapy for laryngeal cancer include aspiration (coughing and infection due to food/fluids trickling into your windpipe) and swelling in the airway causing obstruction and difficulty breathing. This can be relieved by the insertion of a temporary tracheostomy.


Once your radiation therapy ends, you will continue to have follow-up appointments so that your doctor can check your recovery and monitor any side effects that you may have. If you've had advanced stage laryngeal cancer, your doctor may arrange for a PET scan about 12 weeks after finishing radiation therapy to make sure the cancer has completely gone. If the cancer doesn't go away after radiation therapy, or comes back again in the future, you may still be able to have salvage surgery (Total laryngectomy) to try to cure the cancer. 

Your doctor may recommend that you receive specific supportive care to help during your treatment and recovery.