Treating Cervicofacial Tumours

Treating Cervicofacial Tumours

INtroduction

In the cervicofacial region, the area involving the head and the neck, tumours can occur in various places, such as around the nose, sinuses, oral cavity, pharynx, larynx, or saliva glands. Cervicofacial tumours seldom occur, and their treatment is often complex. Therefore, cervicofacial tumour patients in the Netherlands are treated at medical centres employing a multidisciplinary cervicofacial team.

Following extensive research, the Cervicofacial Working Group will provide their recommendations concerning your treatment. One possible treatment is radiation therapy.

The UMCG Radiotherapy department treats around 270 cervicofacial tumour patients every year.

This treatment uses highly advance (photon) radiotherapy technology.

As of the end of 2017, the UMCG will also be able to treat tumours using protons. In principle, this type of proton therapy can also be applied to cervicofacial tumours.

Radiation Therapy and Cervicofacial Tumours

In addition to surgery, radiation therapy is an important and effective treatment for cervicofacial tumours. Since tumours in the area are, by definition, located close to important (healthy) organs, the treatment of cervicofacial tumours is a complex matter.
Radiation treatment also affects the organs surrounding the tumour, leading to complaints like dry mouth or loss of taste. The objective is to reduce the chances of these side-effects by keeping the dose of radiation affecting the surrounding tissue as low as possible. 

Dry Mouth and Swallowing Difficulties

Cervicofacial radiation therapy potentially leads to side-effects that can negatively affect quality of life, such as:

  • Dry Mouth
  • The most frequently occurring side effect of cervicofacial radiation therapy is dry mouth. This, in turn, can lead to swallowing difficulties, (partial) loss of taste or speech, and/or tooth decay.

Studies show that using (photon) radiation treatments leads to dry mouth in around half of all patients treated.
Proton therapy can decrease the impact of radiation on the larger saliva glands, reducing the chances of dry mouth. The extent to which any occurrence of dry mouth can be reversed differs from one patient to the next, however. 

  • Swallowing Difficulties

Cervicofacial radiation therapy results in permanent swallowing difficulties in around a quarter of all patients treated. Complaints range from choking, being able to only eat pureed foods, or reliance on tube feeding. Proton therapy can decrease the impact of radiation on the muscles involved in swallowing, reducing the chances of swallowing difficulties. The extent to which any occurrence of swallowing difficulties can be reversed differs from one patient to the next, however. 

Proton Radiation for Cervicofacial Tumours

The following pictures show that proton therapy in cervicofacial tumours can increase the dose of radiation inflicted on the tumour, while reducing the impact on the surrounding healthy tissue. This may help prevent dry mouth and swallowing difficulties in some cases.

Example 1. Preventing Dry Mouth. Chances of dry mouth for a photon plan and for a proton plan. Example 1. Preventing Dry Mouth. Chances of dry mouth for a photon plan and for a proton plan.

The left image shows a treatment plan for the throat using advanced (photon) radiotherapy technology. The tumour (the treatment area) is irradiated (red), with the blue coloured tissue also exposed to radiation. This blue area also houses the saliva glands. Here, the chances of dry mouth are 60%.

The right image shows a treatment plan for the same tumour using proton radiation. The blue area in this image is smaller than that on the left image, meaning the surrounding tissues are subject to less radiation. The chances of dry mouth are hereby decreased to 45%. 

Example 2. Preventing Swallowing Difficulties. Example 2. Preventing Swallowing Difficulties.

The left image in example 2 shows a treatment plan using advanced photon radiotherapy technology. Based on this plan, the chances of developing serious swallowing difficulties are estimated at 38%.

The right image shows a treatment plan using proton radiotherapy technology. The muscles involved in swallowing are exposed to less radiation, lowering the chances of developing serious swallowing difficulties from 38 to 22%.

Eligibility for Proton Therapy

Proton therapy is not a standard indication for cervicofacial tumours. Therefore, if there is a high risk of developing serious dry mouth and/or swallowing difficulties, two treatment plans are drafted: one using highly advanced photon radiotherapy technology, and one using proton radiotherapy technology. The radiotherapeutic-oncologist then compares both plans and can then determine, using computer generated models, whether your treatment would benefit from proton radiotherapy.

Available Locations

Proton radiotherapy is not yet available in the Netherlands. The UMCG expects to be able to treat cervicofacial tumour patients using proton radiotherapy as of the end of 2017, specifically at the UMC Groningen Proton Therapy Centre, part of the UMCG Radiotherapy department. 

Availability in Groningen

The UMCG expects to be able to treat cervicofacial tumour patients using proton radiotherapy as of the end of 2017, specifically at the UMC Groningen Proton Therapy Centre, part of the UMCG Radiotherapy department. Proton treatments will not be available at the Emmen branch of the UMCG Radiotherapy department.

Your Physicians

The following physicians of the Radiotherapy department specialise in the treatment of cervicofacial tumours.

Prof. dr. J.A. Langendijk Prof. dr. J.A. Langendijk
Dr. H.P. Bijl Dr. H.P. Bijl
Dr. R.J.H.M. Steenbakkers Dr. R.J.H.M. Steenbakkers
J.G.M. Vemer-van den Hoek, MSc J.G.M. Vemer-van den Hoek, MSc

Additional information

More information about cervicofacial tumours, such as causes, complaints, research, treatment, and aftercare, can be found here.