Cancers of the Head and Neck - Radiation Side Effects
The following are the most common side effects, both acute and chronic, resulting from radiation.  Unforeseen side effects may occur because of the unique and varied tolerance of individual persons.  Late effects of treatment may not always be predictable and may be influenced by concurrent and/or subsequent treatment for this and other diseases.  These common side effects include, but may not be limited to the following.

Radiation treatment to the head and neck area is given for a variety of malignant conditions.  These treatments typically last for a total of 5 to 8 weeks and may be administered once per day or twice per day five days per week.  There are many structures in the head and neck region which are sensitive to radiation such that side effects are typically quite prominent. 

Many patients experience fatigue which starts during the second or third week and progresses as the treatment progresses.  This typically subsides gradually over 2 to 6 weeks following the radiation treatment.  This is not normally debilitating and, in itself, should not affect your daily activities or ability to drive.  However, you may wish to go to bed earlier or take an afternoon nap during this period.  Fatigue and weakness are worse in patients who lose weight.  Accordingly, we strongly encourage you to supplement your diet with high calorie foods or commercially available nutritional supplements (for example Ensure Plus, Sustacal, Boost), if necessary to maintain your weight.

Your blood counts may require monitoring periodically during treatment, especially if you also receive chemotherapy.

Skin reaction usually occurs within the treated area with concomitant loss of treated facial hair.  The reaction may resemble a sunburn which typically reaches its maximum during the final week of treatment as well as the first week after treatment, after which it usually subsides fairly rapidly.  There are a variety of topical measures used to alleviate this condition. 

If any salivary tissue is in the path of the beam, there will usually be moderate to severe dryness of the mouth and altered taste.  These problems usually appear within 1 to 3 weeks after starting radiation therapy.  The taste typically returns gradually over a period of several months after completion of the radiotherapy.  Salivary function may or may not return over a period of six months to several years after radiation therapy.  Unfortunately, many patients never recover their salivary function, although there are a variety of measures which may be attempted to improve this condition.

The most severe side effect of head and neck radiation therapy for most patients is soreness inside the part of the mouth or throat which is being treated, combined with increased production of phlegm and/or mucous.  The problem starts after about two weeks of treatment and increases in intensity until the treatment series is completed.  It resolves over a period of 1 to 8 weeks following the radiation therapy.  It may be more severe in patients treated two times per day.  This condition is typically decreased by a variety of measures

Because of the loss of taste, dry mouth and soreness of the membranes which accompany head and neck radiotherapy, many patients will lose a significant amount of weight under treatment.  Your physician and staff will work with you to try to minimize this effect through dietary advice and symptomatic medical management.  In severe cases, more aggressive dietary support may be needed including measures such as placement of a small flexible feeding tube directly into the gastrointestinal tract, bypassing the irritated segment.

If the vocal cords are treated, there may be hoarseness with concomitant sore throat and swallowing difficulty.  These side effects resolve gradually within 2 to 8 weeks after completion of radiation therapy. 

Dental care is extremely important in head and neck cancer patients such that they are referred to the dentist before radiation therapy is started for appropriate cleaning, dental restoration and occasionally, extraction of diseased teeth.  Customized dental trays are also made for the purpose of placing a fluoride gel to be applied to the teeth to decrease the risk of dental decay.  It is an observed fact that patients treated with head and neck radiotherapy have a higher risk of severe dental decay than the rest of the population.  This is made more serious by the fact that uncontrolled dental decay may occasionally precipitate a much more serious reaction in the jaw bone known as osteoradionecrosis.  This condition may range from a brief painful syndrome to a long-term catastrophic complication and is to be avoided if at all possible.  The best way to avoid it is through meticulous attention to proper details of dental care.  The risk of severe injury to the jaw bone is less than 5% with appropriate attention to dental care.  Rarely, catastrophic or fatal injuries may affect other normal tissues such as brain, sensory system, vision, hearing, spinal cord, blood vessels, or skin.  Fortunately, these are very unusual complications.

You may also notice permanent subtle changes in the treated area including the skin.  Inexpensive moisturizing lotion or aloe vera gel is recommended for local dryness or itchiness.  The treated skin may be more sensitive to sun exposure.  Accordingly, we advise wearing clothing or sunscreen over the treated area while spending time outdoors.  This is a lifelong recommendation.

This statement is not a warranty, but it is simply meant to give information regarding typical radiotherapy side effects and their management.  Catastrophic or even fatal radiation complications may occur in rare cases.  Great care will be taken to minimize the side effects and reduce the risk of radiation damage to normal tissues.

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Overview of Head & Neck Cancers
Diagnosis and Treatment Options
Side Effects

For more information see:
San Diego CyberKnife Center - Head & Neck Lesions