Chemoradiotherapy for laryngeal cancer
Treatment with chemotherapy and radiotherapy together is called chemoradiotherapy.
Chemotherapy uses anti cancer drugs to destroy cancer cells. These drugs are also called 
. The drugs circulate throughout the body in the bloodstream.
Radiotherapy uses radiation, usually x-rays, to destroy cancer cells.
Having the two treatments together often works better than having them on their own.
When you might have chemoradiotherapy for laryngeal cancer
You might have chemoradiotherapy:
- on its own as your main treatment for
locally advanced laryngeal cancer instead of surgery. An advantage of chemoradiotherapy in this situation is that you might still be able to speak afterwards. But you might need surgery if there are still signs of cancer after chemoradiotherapy - after surgery to reduce the risk of the cancer coming back
- if the cancer cannot be removed by surgery
Chemoradiotherapy can be difficult to cope with. The side effects are the same kinds of side effects you can get from radiotherapy or chemotherapy alone. But when you have both treatments together some can be more severe.
You will have tests to find out if you are fit enough to have chemoradiotherapy. If you aren't you might be able to have surgery to remove the cancer followed by radiotherapy.
Your doctors consider many things when they plan your treatment. They will explain what treatment you are having and how long you have it for. They will also go through all the possible side effects.
Types of chemotherapy
When you have chemoradiotherapy, you might have any of these chemotherapy drugs:
-
cisplatin
-
carboplatin
-
fluorouracil (5FU)
Check what the name of your regimen is with your doctor or nurse, then take a look at our A to Z list of cancer drugs.
How you have chemotherapy
You have chemotherapy through a drip (an infusion). Your nurse puts a small tube into one of your veins and connects it to the drip, or you might need a central line. This is a long plastic tube that gives the drug into a large vein, either in your chest or in your arm. The tube stays in while you’re having treatment, which might be for a few months.
You might also have some of these treatments as part of a clinical trial.
Where you have chemotherapy
You usually have treatment in the chemotherapy day unit or you might need to stay in hospital for a day or more.
Clare Disney (nurse): Hello, my name is Clare and this is a cancer day unit.
So when you arrive and you’ve reported into with the receptionist, one of the nurses will call you through when your treatment is ready, sit you down and go through all the treatment with you.
Morning, Iris, my name is Clare. I am the nurse who is going to be looking after you today. We’re going to start by putting a cannula in the back of your hand and giving you some anti sickness medication. And then I am going to come back to you and talk through the chemotherapy with you and the possible side effects you may experience throughout your treatment. Is that okay?
Before you have each treatment, you’ll need to have a blood test to check your bloods are okay. And you’ll also be reviewed by one of the doctors to make sure you’re fit and well for your treatment. Sometimes you’ll have the blood test taken on the day of your treatment; other times you’ll have it the day before your treatment when you see the doctor.
Each chemotherapy is made up for each individual patient, depending on the type of cancer they have and where it is and depending their height, weight and blood results.
So, depending on where your cancer is some people have their chemotherapy drug, their cancer drug by drip, some will have an injection and other people will have tablets.
So, Iris, your chemotherapy is going to be given to you in what we call cycles and the cycles are given every three weeks for a period of six cycles. So, you will be coming in for approximately five months for your chemotherapy.
Depending on where your cancer is and what type of cancer you have will be dependent on how often you come in for treatment. An example of a treatment cycle would be for you to come in on Day 1, Day 8 and Day 15 then to have a week’s break before you come back again for Day 1 treatment.
Depending on the type of treatment that you are having, we will also give you some anti sickness tablets to take alongside your chemotherapy and also some drugs to prevent any reactions if that’s appropriate.
All chemotherapy is given over different time periods, so it’s best to check with your nurse about how long you are likely to be in the unit for. This can range from anything up to an hour to an all day treatment slot, so please be prepared to bring along some bits to keep you occupied books and music.
So, before you go home it’s important to make sure you have got the tablets you need to go home with your anti sickness medications and any other symptom control tablets that you may require. Also, to make sure that you’ve got the telephone numbers for the oncology unit to phone if you have a temperature or you are experiencing any other symptoms at home that you need to ask advice about.
So, please make sure when you leave the unit that you’ve got all the information you require and if you’ve got any questions at all don’t hesitate to ask the nurse, who will be able to answer them for you.
Before your next cycle of treatment you will come in and see the doctor in the clinic room. You’ll have a blood test and an examination to make sure you are fit and well for treatment. You will then come back the following day or later on that week for treatment.
Having radiotherapy
Planning your treatment
Before you begin treatment, the radiotherapy team works out how much radiation you need. They divide it into a number of smaller treatments. They call each treatment a fraction.
You have a mask made before you start radiotherapy.
Daniel (radiographer): Before your treatment starts your doctor will need to work out exactly where the treatment needs to go and also which parts need to be avoided by the treatment.
To have radiotherapy you lie in the same position as you did for your planning scans.
To stop you moving and to make sure your treatment is directed at the cancer you wear a custom mask over your face which is attached to the couch.
We line up the machine using marks on your mask and then leave the room. We control the machine from a separate room this is so we aren’t exposed to radiation.
Treatment takes a few minutes and you’ll be able to talk to us using an intercom. We can see you and hear you while you’re having treatment and we will check that you’re OK.
When your treatment starts you won’t feel anything. You may hear the machine as it moves around you giving the treatment from different angles.
Because we’re aiming to give the same treatment to the same part of the body every day the treatment process is exactly the same everyday so you shouldn’t really notice any difference.
You’ll see someone from the team caring for you once a week while you’re having treatment. They’ll ask how you are and ask about any side effects.
Having treatment
It can take a few days or up to 3 weeks before you start treatment.
You lie under a large machine to have radiotherapy.
Tests
You need to have blood tests to make sure it’s safe to start treatment. You usually have these a few days before or on the day you start treatment. You have blood tests before each round or cycle of treatment.
Your blood cells need to recover from your last treatment before you have more chemotherapy. Sometimes your blood counts are not high enough to have chemotherapy. If this happens, your doctor usually delays your next treatment. They will tell you when to repeat the blood test.
Treatment cycles
You take some cancer medicines in treatment cycles. This means you take the drug for a set period, followed by a break. For example, you might take a drug every day for a week and then not take it for 2 weeks. This 3 week period in total is one cycle of treatment.
Take your cancer drugs exactly as your doctor, specialist nurse or pharmacist has told you to. The break from treatment is important too. For many cancer drugs, it allows your body to recover.
Side effects of chemoradiotherapy
Most people will have side effects from chemoradiotherapy for laryngeal cancer. Combining chemotherapy and radiotherapy can make side effects worse. But everyone is different and the side effects vary from person to person. You might not have all the side effects mentioned.
Side effects depend on:
- how well you are before treatment
- which chemotherapy drugs you have
- how much of each drug you have
- the dose of radiotherapy
- how long you have your radiotherapy treatment for
Chemotherapy side effects
Common chemotherapy side effects include:
- feeling sick
- loss of appetite
- losing weight
- feeling very tired
- increased risk of getting an infection
- bleeding and bruising easily
- diarrhoea and constipation
- hair loss
Contact your doctor or nurse if any of the side effects are severe. Or contact them if your temperature goes above 37.5°C or below 36°C. Infections can make you very unwell very quickly.
Radiotherapy side effects
Common radiotherapy side effects include:
- a sore mouth and throat
- feeling very tired
- difficulty swallowing
- feeling or being sick
- voice changes
- reddening or darkening of the skin in the area you have your radiotherapy
Smoking
If you smoke, your doctor will advise you to stop. Smoking during treatment can make the side effects much worse.
