Radiation therapy uses high-energy radiation to kill cancer cells. It can be used as the main (primary) treatment of nasal cavity and paranasal sinus cancer in some cases. Patients with small nasal cavity tumors can often be cured with radiation alone with less change in their facial appearance than if they had surgery. Patients whose general health is too poor to undergo surgery may receive radiation therapy as their only treatment.

Often, after surgery, radiation therapy will be used to kill very small deposits of cancer that cannot be seen and removed during surgery. This is called adjuvant treatment. It also may be given before surgery to shrink the tumor so it is easier to remove. This is called neoadjuvant treatment. Radiation therapy can also be used to help with symptoms like pain, bleeding, and difficulty swallowing. This is known as palliative treatment. It is also used when the cancer has spread to the brain or spinal cord. There are 2 major types of radiation therapy -- external beam radiation therapy and brachytherapy.

External beam radiation therapy

The most common way to deliver radiation to a paranasal or nasal tumor is to carefully focus a beam of radiation from a machine outside of the body. This is known as external beam radiation. To reduce the risk of side effects, doctors carefully figure out the exact dose you need and aim the beam as accurately as they can to hit the target area. External beam radiation therapy usually means having treatments 5 days a week for a period of about 6 to 7 weeks. Intensity modulated radiation therapy (IMRT) is a form of external beam radiation therapy in which the radiation beam is focused so that it is better shaped to the contours of the tumor. This reduces the dose of radiation to the surrounding normal tissue, decreasing some side effects.

Brachytherapy

Another method of delivering radiation is to insert (implant) very thin metal rods containing radioactive materials in or near the cancer. This method is called internal radiation, interstitial (in the tissue) radiation, or brachytherapy. This is sometimes done if the cancer comes back after external beam radiation therapy.

The implant is usually left in place for several days while the patient stays in a private hospital room. The length of time that visitors, nurses, and other caregivers can spend with the patient may be limited because of potential radiation exposure, but this depends on the type of radiation. The implants are removed before the patient goes home. Sometimes, both internal and external beam radiation therapy are used together.

Side effects of radiation therapy

Common side effects include:

• skin problems (like a sunburn)
• nausea
• loss of appetite
• feeling tired or weak
• mouth/throat pain, sores in the mouth, and trouble swallowing (called mucositis)
• hearing loss
• hoarseness
• problems with taste
• bone pain
• bone damage

Problems with mucositis can be severe enough that patients have trouble eating and drinking. This can lead to weight loss and malnutrition. Some people need to rely on tube feedings during treatment to keep up their strength. With tube feedings, a liquid food is given through a tube that is placed directly into the stomach.

Most of these symptoms will go away a short while after the radiation is finished, but some side effects can be permanent. For example, if an eye lies in the path of the radiation beam, the vision may be damaged. Also, radiation therapy to the head or neck area often damages the salivary (spit) glands, causing the mouth to become very dry. This can lead to problems with eating and swallowing and also cause tooth problems. This is a very common side effect of radiation therapy to the head and neck areas, and is often permanent. This side effect can be lessened if a drug called amifostine (Ethyol^®) is given before each radiation treatment. There are also fewer problems with dry mouth if IMRT is used. Also, if the pituitary or thyroid glands are exposed to radiation (irradiated), their production of hormones may decrease over time. This can lead to problems with metabolism that may need to be corrected with medicine. Sometimes chemotherapy is given with radiation to help it work better. This is called chemoradiation, and it has more severe side effects than when radiation is given by itself. However, there are ways to relieve many of the side effects caused by radiation, so it is important to discuss these symptoms with your cancer care team.

Last Medical Review: 08/13/2009
Last Revised: 08/13/2009