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patients experience more side effects if the radiation field is large enough to hit the saliva glands, teeth or lining of the mouth

Side Effects of Oral/Throat Irradiation 

(read reviews here and here and here for nursing instruction sheets go here, for more specific information go here and for a detailed list of side effects go Here, for treatment advice go here and for more on radiation techniques go here. People who keep smoking have more complications (go here).

Unfortunately radiation to the head and neck region probably causes more patient discomfort than treatment to any other site. It is important for patients to understand this before starting therapy and to work with the medical team to minimize and try to prevent problems as much as possible. As the daily radiation continues almost everyone gets more symptoms (go here). A recent study of intensive chemo-radiation showed good results (over all survival rate of 89%) but it took an average of 9 - 10 months before they could remove the patient's feeding tube (go here).

The area treated is critical to side effects. If just the larynx (vocal cord cancer) is being treated the symptoms may be mild (skin irritation, hoarseness and slight sore throat.) If a large area of the mouth is treated (including the saliva glands and teeth) then the patient may have considerable side effects (particularly if combined with chemotherapy) and a much higher risk of long term problems (e.g. permanent dryness and increased risk for dental problems.) Efforts are made to shield the parotid glands to less than 26Gy (go here) which may cause less dryness (go here). Other parotid dose advice is here and radiation to the throat here.

Patients receiving high dose radiation to a large area combined with chemotherapy may expect at some point to need a feeding tube (e.g. gastrotomy tube or PEG tube) and high dose pain medication (e.g. Duragesic patches.)  

Complications caused by radiation therapy Radiation to the head and neck can cause the same oral problems as chemotherapy and can also damage glands that produce saliva and the muscles of the jaw and neck, and bone. High-dose radiation to the bones that hold the teeth can cause a reduction in the level of oxygen in the tissues, less blood supply to the bones, and tissue breakdown leading to exposed bone, infection, and tissue death.  Both radiation therapy to the head and neck and chemotherapy drugs affect the ability of cells to divide, making it difficult for tissue in the mouth to repair itself. Radiation damage occurs in the site that is irradiated. The damage depends on the amount and kind of radiation used, the total dose used, and the size of the area irradiated. Damage caused by radiation therapy affects the tissues for the rest of the patient's life. These tissues are more easily damaged at a later time by drugs or radiation, and normal methods of cell repair do not work as well once cells are permanently destroyed.

Complications caused by chemotherapy Since cells in the mouth (and gastrointestinal tract) grow and die at a similar rate as white blood cells, the time that the mouth tissues are most damaged is when the white blood cell count is lowest. When the white blood cell count returns to normal, the mouth is able to recover. The lips, tongue, bottom of the mouth, inside of the cheeks, and soft palate (the upper back of the mouth) are more affected by chemotherapy drugs than are the hard palate (the upper front of the mouth) and the gums. Some chemotherapy drugs are more likely to cause problems in the mouth, especially when they are given in high doses, in repeating schedules, or along with radiation therapy (for example, therapy given before bone marrow transplant).