Proton Therapy for Head and Neck Cancers

For patients with complex head and neck tumors, proton therapy allows us to treat the tumors effectively while minimizing the radiation dose to vital structures such as the eyes, mouth, and brain. That means a patient’s vision, smell, taste, and swallowing may not be affected by proton therapy. It also means side effects such as nausea, severe dry mouth, difficulty swallowing, loss of taste, and thyroid dysfunction are not as severe with proton therapy.

But some head and neck cancer patients will experience skin irritations, mouth sores, sore throat and painful swallowing due to the tumor and treatment location. 

As nurses at MD Anderson Proton Therapy Center, we get a lot of questions from head and neck cancer patients and caregivers about managing these proton therapy side effects. Here’s how we answer some of the most common ones.

How do I deal with skin irritations from proton therapy?

We recommend that patients wash the affected skin daily with mild moisturizing soap to cleanse. Use an unscented moisturizer starting on the first day of treatment. Do not use anything abrasive on the skin, and avoid wearing shirts with collars. Use an electric razor, and avoid aftershaves or perfumes. Do not apply makeup to the affected area and avoid direct sunlight.

Why is oral care important during proton therapy?

Oral care is important during and after treatment. Mouth sores can become infected, so practice good oral hygiene and tell your care team about any symptoms. Use baking soda and salt rinses four to six times a day. This helps the PH balance and reduces bacteria in your mouth. Brush your teeth with a soft toothbrush after every meal and at bedtime. Avoid commercial mouthwashes that contain a large amount of salt or alcohol.

Also be sure to perform the jaw and neck exercises as instructed by your medical team. These exercises will help with stiffness or tightening of the jaw and neck, mouth opening challenges, and difficulty chewing.

How do I avoid unwanted weight loss?

Many cancer patients lose weight unexpectedly because they struggle with nausea or cannot eat well during treatment. Proper nutrition can help you maintain your weight and hydration, which helps ensure successful treatment results. Good nutrition will also improve your quality of life during and after cancer treatment.

Eating soft, moist foods and avoiding anything that irritates your mouth, such as spicy, rough, acidic, extreme temperatures, or carbonated drinks. If you’re having trouble eating, you may want to try meal replacement drinks like Boost and Ensure. It's also important to talk to your doctor about any vitamins, nutritional or herbal supplements you're taking. 

You should also avoid drinking alcohol or using tobacco products, as these habits can increase treatment side effects.

How can I prevent dry mouth?

Dry mouth can make eating, speaking, and sleeping more difficult. Without saliva, patients also run the risk of increased bacterial growth, bone infection, and nutritional deficiencies.

You can avoid dry mouth by chewing sugar-free gum, over-the-counter saliva substitutes, and staying hydrated. It also helps to swish a baking soda/water solution around your mouth a few times a day. It may be beneficial to sleep with a cool-mist humidifier next to your bed during and after treatment as well.

How can I reduce fatigue?

Fatigue is a normal and often expected side effect of cancer treatment. Try taking naps earlier in the day so that you don’t disrupt your sleep pattern.

Some patients find their fatigue improves with light exercise such as walking. Be sure to check with your care team before starting a new exercise routine.

What can I expect after proton therapy for head and neck cancers?

Side effects from proton therapy may continue or even increase for two to three weeks after treatment for head and neck cancer patients. Be sure to continue the regimen your care team recommends for caring for your mouth, throat, skin, and maintaining proper nutrition. It usually takes four to six weeks for your body to heal after proton therapy.

Remember, your care team is here for you and will provide resources and specific product recommendations for your side effects. Be sure to follow them. The patients that do the best are those who get ahead of their side effects.

Request an appointment at MD Anderson online or by calling 1-877-632-6789.

After a series of nosebleeds in 2005, I was diagnosed with a rare form of cancer called olfactory neuroblastoma. I had surgery to remove the skull base tumor in my sinus cavity, followed by radiation therapy. I was then cancer-free for almost 15 years.

But in September 2019, I discovered a lump on the side of my neck. The cancer had returned and spread to my lymph nodes.

An MRI confirmed that the tumor had returned in my sinus cavity. In November 2019, I underwent two rounds of chemotherapy, followed by two surgeries in January and February 2020. The first surgery was to remove the cancer in my lymph nodes. The second surgery was to go back in my sinus cavities and remove the skull base tumor that had returned. Since I had received radiation therapy previously, my doctors recommended that I receive proton therapy this time. At my doctor’s recommendation, I came to the MD Anderson Proton Therapy Center.

My olfactory neuroblastoma treatment at the Proton Therapy Center

My proton therapy treatment was scheduled in March 2020, right after the COVID-19 pandemic started. Since we live in South Carolina, my family and I made the 15-hour drive to MD Anderson in Houston. The schools were closed during this time and my wife could work from home, so we brought our 6- and 9-year-old children with us.

Radiation oncologist Dr. Brandon Gunn helped me through proton therapy with ease. I received treatment five days a week. I had a small amount of hair loss on the back of my head and a rash on the side of my neck and face where the radiation was most concentrated. My care team recommended that I stay out of the sun to let my skin heal.

The Proton Therapy Center nutritionist, Haley Deas, gave me guidance on what to eat if I had trouble swallowing because of the radiation. However, I did not have those side effects.

The staff at the Proton Therapy Center were extremely professional and thorough. They went out of their way to make sure my treatment went smoothly.

Life after olfactory neuroblastoma treatment

We returned home to South Carolina in early May. Fortunately, my job as a compliance officer at a bank has allowed me to work from home since my olfactory neuroblastoma diagnosis in October 2019.

So far, all my scans have come back negative for new tumors.  My follow-up appointment with Dr. Gunn in August will be a virtual visit, so we will not have to make the trip back to Houston as the COVID-19 pandemic continues.

 I now appreciate each day a little more and try not to let unimportant things bother me or worry much. Life is short enough as it is. When I was undergoing chemotherapy, surgeries and proton therapy, there were times when I got discouraged, but I reminded myself to keep moving forward. After all, that is the only direction to go.

Request an appointment at MD Anderson online or by calling 1-877-632-6789.