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 spearfishing trip, I noticed an unusual earache. When spearfishing, it is typical to dive down 50 to 60 feet in the water to fish, so I thought it was simply some water in my ear. Then my lymph node in my neck became swollen. 

In October 2022, I went to see my primary care doctor. She prescribed an antibiotic and eardrops. She told me not to worry and to follow up if things did not improve. I procrastinated and did not go back until January 2023 when I was due for my annual physical exam. When I mentioned my lymph node was still swollen, she scheduled a test and then referred me to an ENT to have a biopsy. Things were moving quickly, and that gave me a lot of anxiety. I knew something was wrong. 

Results from the biopsy showed that I had a head and neck cancer called squamous cell carcinoma on the right side of my neck.  

Facing my squamous cell carcinoma diagnosis

At a local hospital in Florida, I had robotic surgery on the back of my throat to remove the cancer, along with 32 lymph nodes. After surgery, a biopsy showed microscopic spreading, even though they had clear margins when removing the tumor. Two of the 32 lymph nodes in my neck tested positive for cancer. The doctors suggested I start chemotherapy and traditional radiation therapy. But I wanted a second opinion.

I have always had trouble swallowing, so I was scared that side effects from radiation treatment would make it worse. My brother, Dion, lives in Houston and connected me with a friend who had the same type of cancer. Everyone told me to get multiple opinions from various hospitals. 

So, a week later, I visited another cancer hospital. They said the cancer was confined and suggested proton therapy since I only needed radiation to one side of my neck. The benefit of proton therapy is that the radiation could be delivered to only one side of my neck. This would minimize side effects to the other side of my neck, as well as my eyes, mouth and brain.

Once I found out that proton therapy was the right treatment for me, I was relieved. I wanted to find the best proton treatment facility I could. 

Finding care and compassion at MD Anderson

At the beginning of April, I made plans to get another opinion at MD Anderson because I knew they were the top cancer hospital in the nation. 

The day I was supposed to leave for Houston, I got busy at work and almost canceled the trip. At the last minute, I decided to go. 

At MD Anderson, I had appointments with my full care team to review my case and set up my treatment plan. I met with medical oncologist Dr. Neal Akhave, radiation oncologist Dr. Steven Frank, along with physical therapy, speech therapy, hearing and dental oncology. 

At my first appointment with Dr. Frank, I remember asking him why I should come to MD Anderson for proton therapy. He mentioned that proton therapy is like a scalpel. Everyone has one, but it is who is using the scalpel that matters. 

“We give patients the full benefit of resources of the nation’s top-ranked cancer center, such as knowledge, expertise, world-renowned research, clinical trials and technology,” says Frank.

Making that trip to MD Anderson to meet Dr. Frank and the rest of my care team changed the course of my treatment. 

Dr. Frank took the time to explain the process. That put me at ease. When he learned that my brother Dion and I attended the Naval Academy, at my next appointment, he surprised us by walking in wearing his former Naval Submarine Officer uniform. That level of compassion and camaraderie was like nothing I had experienced with any other doctor. 

Managing side effects from treatment

My wife, Karen, stayed in Florida while I traveled to Houston to begin treatment. I lived with Dion and worked remotely every day. I rented a car to drive myself to daily treatments for six weeks of chemotherapy and proton therapy. 

Toward the end of chemotherapy, I experienced nausea, so I took medication to help. The lymph node dissection during surgery caused lymphedema in my neck and limited the range of motion in my arm. I still cannot raise my arm as normal but have started physical therapy. The surgery also severed nerves in my neck, making it hard to open the corner of my mouth, which is expected to be permanent. 

The side effects from proton radiation were not as bad as I anticipated. I had a slight sunburn at the site of radiation, but it improved after two weeks. I ate my normal diet, but I did lose my sense of taste temporarily. I gained a few pounds during treatment, which I was not expecting.

Getting a second opinion led me to the right treatment for me

My last treatment was on June 7, 2023. As a token of appreciation, I ordered personalized Navy hats for Dion and Dr. Frank, along with a custom submarine photo and a Zippo lighter. These are typical Navy gifts, and I wanted to show my appreciation to them both.   

Had I known about proton therapy from the beginning, I would not have had surgery. 

If you have any doubts about your diagnosis or treatment plan, get a second opinion. I spent five weeks getting several opinions for my treatment options. Even though I did not learn about proton therapy until week four, it was the perfect solution. 

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