Radiation Therapy for Oral Cancer

Radiation therapy is most often used after surgery to destroy any cancer cells that may remain in the oral cavity. If doctors think radiation therapy can destroy an oral cancer tumor and enable them to preserve chewing, swallowing, and speaking function, they may recommend this treatment instead of surgery.

Radiation therapy may also be combined with chemotherapy or targeted drugs. This approach is called chemoradiation and is typically recommended when there is a high risk of cancer cells remaining after surgery.

Radiation oncologists at NYU Langone use CT scans in conjunction with treatment planning software to customize radiation therapy. During this planning session, you are custom-fitted with a mask. The mask helps you to remain still as your doctor precisely plans the delivery of radiation therapy.

Using CT scan results, the software creates a three-dimensional image of the oral cavity, the tumor or site from which it was removed, and the surrounding structures, such as the jawbone, the muscles used to chew, and the salivary glands.

These images of the oral cavity and surrounding structures assist the doctor in delivering targeted radiation doses.

A special technology called cone-beam CT is also used before each treatment to ensure radiation therapy is delivered precisely. This imaging allows doctors to view the treatment area and adjacent critical organs and structures. This enables them to adjust the delivery of radiation to reflect changes in body positioning, weight loss, and tumor shrinkage.

Doctors at NYU Langone may use intensity modulated radiation therapy after surgery for oral cancer to destroy any remaining cancer cells. It is also sometimes used to manage oral cancer in people who cannot tolerate surgery.

With this therapy, a machine delivers the radiation beams from different directions. This type of radiation therapy is broken into many small, computer-controlled doses of differing strengths.

Tailored to the size, shape, and location of the tumor or the site from which the tumor was removed—called the tumor bed—these “minibeams” enable doctors to deliver high doses of radiation to specific areas while avoiding nearby healthy tissue. Radiation therapy is delivered in doses called fractions—typically once daily, five days a week, for six or seven weeks.

Intensity modulated radiation therapy may be combined with chemotherapy. This approach, called chemoradiation, may be used to destroy any remaining cancer cells after oral cancer is surgically removed. It may also be used after surgery in people who have cancer that has spread to the lymph nodes.

Brachytherapy is a form of therapy in which radioactive materials are placed directly into the oral cavity. This allows the radiation dose to be highly concentrated in the tumor while sparing surrounding healthy tissue.

Brachytherapy may be used instead of surgery to manage small oral cancer tumors, especially if doctors think it could help to preserve more chewing, swallowing, and speaking function. Brachytherapy may also be used after surgery to destroy any remaining cancer cells or to manage tumors that have recurred.

Brachytherapy may be combined with intensity modulated radiation therapy to destroy tumors. Combined therapy allows radiation oncologists to use lower doses of external radiation therapy, which reduces the exposure of healthy tissue to the treatment. Brachytherapy is used following external therapy to increase the radiation dose directly to the tumor.

To deliver this type of radiation, NYU Langone doctors place catheters, or small tubes, directly into the tumor or the tumor bed. Radioactive material is delivered into the catheters, usually a day after the catheter placement.

Catheter placement and radiation delivery take place in the hospital and require general anesthesia. Treatment typically lasts two to seven days. After treatment, all catheters and radioactive materials are removed before you go home.

Side effects during treatment can include dry mouth, changes in taste, sunburn-like skin changes, and nausea related to excess mucus production in the mouth. Near the middle or end of radiation therapy, people may experience mouth sores, difficulty swallowing, hair loss, and fatigue.

Radiation therapy may also cause tightening of the muscles in the face and around the jawbones, making speaking, chewing, and swallowing difficult.

Most of these side effects subside after treatment ends, although dry mouth may last for up to two years.

To ease discomfort, doctors can prescribe medication or refer you to NYU Langone’s integrative health services. Nutritionists, speech and swallowing therapists, and physical therapists are also available to help manage treatment side effects.