Radiation Therapy for Oropharyngeal Cancer

Radiation therapy may be used alone or combine it with chemotherapy, an approach known as chemoradiation. Doctors may also recommend brachytherapy, a type of radiation therapy in which radioactive material is placed directly into a tumor.

If these treatments don’t fully destroy a tumor, your doctor may also recommend surgery.

Radiation oncologists at NYU Langone use CT scans in conjunction with treatment-planning software to customize radiation therapy. Using CT scan results, the software creates a three-dimensional image of the oropharynx, the tumor, and the surrounding structures, such as the jawbone, muscles, salivary glands, and the thyroid gland, which helps regulate metabolism. The resulting image helps doctors deliver targeted radiation doses.

Doctors at NYU Langone typically use intensity modulated radiation therapy to manage oropharyngeal cancer. With this therapy, a machine that rotates around you delivers the radiation beams. The beams travel from different directions and are broken into many small, computer-controlled doses of different strengths.

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

Most often, a special imaging technique called a cone-beam CT is performed daily to check that you are positioned properly before radiation therapy is delivered.

In people who have a small tumor on one side of the oropharynx, NYU Langone radiation oncologists may deliver radiation therapy only to that side to spare healthy tissue on the other side of the neck. This approach avoids important structures, such as the salivary glands, swallowing muscles, jawbones, and carotid artery.

Doctors may also deliver radiation therapy to area lymph nodes on the side of neck where the tumor is located. This enables them to destroy any microscopic cancer cells that may have spread to these nodes.

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

Brachytherapy is delivered while you receive general anesthesia. NYU Langone doctors place catheter tubes directly into the tumor and radiation material is delivered into the catheters, usually the next day. All catheter placement and radiation delivery occurs while you are in the hospital, typically during a two- to seven-day period. After treatment, all catheters and radioactive material are removed before you return home.

This approach may be combined with intensity modulated radiation therapy to manage small oropharyngeal tumors at the base of the tongue and to reduce side effects. Brachytherapy is used to boost the radiation dose to the tumor after a reduced dose is delivered with intensity modulated radiation therapy. This combined treatment increases the amount of radiation delivered to the tumor while minimizing the dose to healthy tissue.

Many side effects of radiation therapy subside after treatment, although some may be long lasting or permanent. Radiation therapy may damage the salivary glands, causing dry mouth. It may also cause tightening of the muscles in the face and around the jawbones, making speaking, chewing, and swallowing difficult.

To ease any discomfort, doctors can prescribe medication, or refer you to integrative health services. Speech and swallowing therapists and physical therapists at NYU Langone are also a part of the treatment team.