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.

As a retired Navy hurricane research pilot, I don’t leave anything up to chance. When I was with the National Oceanic Atmospheric Administration (NOAA) Corps, I flew a P-3 into the eye of Hurricane Hugo. We were hit by a tornado, lost an engine and were trapped for two-and-a-half hours. So, in January 2011, when I discovered a lump on my jaw that didn’t feel right, I made an appointment with my ENT.

The ENT recommended I see a surgeon and have a biopsy. My doctor told me that I had oropharynx squamous cell carcinoma – a cancer of the throat and neck that had spread to the back of my tongue and the lymph nodes in my neck. It was caused by the human papillomavirus (HPV).

After my wife died of ovarian cancer in 2005, I’d made a promise to myself to be proactive about my health. So, I went home and started to figure out how I would get to MD Anderson.

After doing my research, I wanted to see if I was a candidate for proton therapy at MD Anderson Proton Therapy Center. I called to get an appointment at MD Anderson Proton Therapy Center, found an apartment in Houston, and traveled there for my first visit and scans.

First oropharynx cancer patient in the nation to receive IMPT

My care team determined that the best treatment for me was proton therapy and weekly injections of monoclonal antibodies. My radiation oncologist, Dr. Steven Frank, suggested that I join the Intensity-Modulated Scanning Beam Proton Therapy (IMPT) clinical trial. I would be the first oropharynx patient in the nation to receive IMPT.

IMPT is one of the most advanced forms of proton therapy. It delivers a precise dose of protons to tumors embedded in the nooks and crannies of the head and neck, including the base of the tongue and tonsils.

Dr. Frank said IMPT would preserve my ability to taste and maintain proper functionality of my salivary glands. 

In order to receive proton therapy, I would need to have 14 gold crowns removed from my teeth since they would interfere with the radiation. So, I flew back home to Florida on a Friday, had my dentist remove seven crowns from my mouth on Saturday and seven more on Sunday. I returned to Houston the next day to begin six –and-a—half-weeks of proton beam radiation. I knew my cancer had already spread so I wanted to start treatment as soon as I could. After treatment, when I returned to Florida, my dentist put my gold crowns back in my mouth.

Coping with side effects from IMPT

The first three weeks of treatment were the hardest. I didn’t know anyone in Houston. My care team became my biggest support system. I saw Dr. Frank every week. He made sure that everything stayed on track. He helped me stay positive and committed.

The monoclonal antibodies injections caused my skin to temporarily break out. The proton therapy caused dry mouth, sore throat and fatigue. I was still able to go for daily walks and eat three meals a day. I drank smoothies for breakfast and lunch and made myself eat a meal for dinner, even when I couldn’t taste it. I knew I needed the nutrition to keep going.  

During treatment, I tried to make someone laugh every day. I made a point to talk to other patients in the lobby. You have a choice every day to be happy or be a grouch. Make the choice to spread happiness.

At my last proton therapy treatment on May 5, 2011, I vividly remember my nose starting to itch. Because of the treatment mask, I couldn’t move. I decided to focus on the music playing in the treatment room instead. That helped a lot. I would wiggle my toes with the music to show the therapists I was dancing during treatment. 

Everyone at the Proton Therapy Center was fantastic. From the nurses I taught to two-step in the treatment room to the physicist who grew up in an area of China I’d served in, everyone was fully invested in ensuring I beat the disease.

Living life to the fullest after cancer treatment

It’s been 10 years since my treatment at MD Anderson. I continue to spread the word that there is no place to receive proton radiation treatment quite like MD Anderson. I tell people that if you want to get the best, even if you must travel, go to MD Anderson. People don’t realize that you only give up a few months of your life to gain many more healthy years.

When you have stage IV cancer and it’s already spread to your lymph nodes, you just feel thankful to be alive. I know this firsthand: I’ve been able to do a lot of things in my life the past 10 years, thanks to the treatment and clinical trial opportunity that I received at MD Anderson.

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