Radiotherapy and Chemotherapy for Head and Neck Cancer
A practical explanation of IMRT schedules, cisplatin-based chemoradiotherapy, induction chemotherapy, acute and late side effects, and what to plan for during a six-to-seven-week course.
A curative radiotherapy course for head and neck cancer usually uses intensity-modulated radiotherapy (IMRT) delivered once daily on weekdays for about 33 fractions over six to seven weeks. Cisplatin-based chemotherapy is given concurrently for locally advanced disease; induction chemotherapy may precede it. Acute mucositis, skin reaction, dry mouth and swallowing difficulty are common and need proactive supportive care.
What is IMRT and how long does it take?
IMRT shapes the dose to the tumour while sparing normal structures.
Intensity-modulated radiotherapy uses computer-controlled beam shapes to deliver a high dose to the tumour and at-risk nodal regions while limiting dose to the parotid glands, mandible, swallowing muscles, spinal cord, brainstem and temporal lobes. A typical definitive course is about 70 Gy in 33–35 fractions over six to seven weeks; postoperative courses are commonly 60–66 Gy. Each daily session lasts only minutes, but positioning and verification take longer.
Proton therapy may be considered for skull-base, sinonasal and re-irradiation cases where sparing critical normal tissue is especially valuable; availability and cost vary widely between countries.
What does chemotherapy add?
- Concurrent chemoradiotherapy: cisplatin (commonly 100 mg/m² every three weeks in guideline protocols) radiosensitises the tumour and treats micrometastatic disease.
- Induction chemotherapy: TPF (docetaxel, cisplatin, 5-FU) or gemcitabine + cisplatin given before radiotherapy, used in locally advanced nasopharyngeal carcinoma and selected larynx-preservation protocols.
- Adjuvant or palliative chemotherapy: used after surgery with high-risk features or for symptom control in metastatic disease.
- Before each cycle: blood counts, kidney and liver function, hearing assessment and hydration planning; a central venous catheter (PICC) may be placed to protect veins.
Which side effects should I expect, and what helps?
| Effect | Typical timing | What helps |
|---|---|---|
| Mucositis and mouth pain | Weeks 2–6 | Topical anaesthetics, prescribed analgesia, saline/bicarbonate rinses, antifungal review |
| Skin redness, peeling | Weeks 3–7 | Gentle cleansing, prescribed emollients, no sun exposure to the field |
| Dry mouth and thick saliva | From week 2–3, may persist | Frequent water, saliva substitutes, fluoride trays, pilocarpine where appropriate |
| Taste loss | Weeks 2–8, often recovers over months | Nutritional support, texture and flavour adjustment |
| Difficulty swallowing | During and after treatment | Daily swallowing exercises, early dietetic input, feeding tube if needed |
| Low blood counts, nausea | During chemotherapy cycles | Monitoring, anti-emetics, dose adjustment, infection precautions |
| Trismus (limited mouth opening) | Months to years after | Daily mouth-opening exercises from day one |
Practical planning for an international patient
- Plan on staying near the hospital for the whole six-to-seven-week course plus a response assessment; daily weekday attendance is required.
- Complete dental extractions and fluoride prophylaxis before simulation, with enough healing time.
- Ask for the written prescription: total dose, dose per fraction, number of fractions and target volumes.
- Request a weekly review with a nutritionist and speech-language pathologist — proactive swallowing therapy reduces long-term feeding-tube dependence.
- Carry the full radiotherapy record (DICOM or printed dose sheet) home; it is essential for any future re-irradiation or surgery.
Frequently asked questions
Is radiotherapy painful?
The treatment itself is painless. Side effects accumulate over the course: by weeks two to four most patients have some mouth soreness, altered taste and skin reaction, and pain control, nutrition and swallowing support become central to care.
Can I fly home during a course of radiotherapy?
Not for a curative course. Missed or prolonged fractions reduce tumour control, and acute side effects peak near the end. If treatment must be transferred, the two radiation oncology teams must formally reconcile dose, fractionation and planning images.
Will I lose my hair?
Only in the treated field. Head and neck radiotherapy can cause loss of beard, scalp hair in the beam path or neck hair; cisplatin-based chemotherapy used in these protocols does not usually cause the generalised hair loss typical of other chemotherapy regimens.
How long do dry mouth and taste changes last?
Taste often begins recovering within weeks to months and may continue improving for a year or more. Salivary recovery depends on the dose to the parotid glands; with IMRT many patients improve over six to twelve months, but some have permanent xerostomia requiring lifelong dental protection.
Sources for this guide
Applying this to your own case?
Start with a remote review of your records, then compare the written plan with the options you have at home.
Records checklist How to compare plansMedical disclaimer: This knowledge base is general information for people researching head and neck tumours, not a diagnosis or treatment plan. It does not replace an examination by a qualified physician. Survival figures are population averages, not predictions for an individual. Treatment and cost estimates for China are illustrative only and must be confirmed in writing after your records have been reviewed. If you have a symptom lasting more than two to three weeks, see a doctor promptly.