4.2.2 Radiation therapy

Radiation therapy can be used as the primary curative treatment of several head and neck cancers and may be given concurrently with systemic therapy. It can be given following surgery (postoperatively) for patients at high risk of locoregional recurrence. It is also useful in palliative care.

Patients should have access to a dietitian and a speech pathologist within the radiation therapy centre, who should liaise closely with their counterparts in the patient’s local support team.

Outcomes are improved for patients receiving curative radiation therapy for head and neck cancers when they are treated by radiation oncologists who have larger head and neck cancer caseloads (Boero et al. 2016; Wuthrick et al. 2014).

Timeframe for starting treatment

Radiation therapy as a primary treatment:

  • for curative intent – start within four weeks of the MDM
  • for palliative intent – start within two weeks of the MDM.

Radiation therapy as an adjuvant treatment should begin within six weeks after surgery.

Training and experience required of the appropriate specialists

Fellowship of the Royal Australian and New Zealand College of Radiologists or equivalent, with adequate training and experience, institutional credentialing and agreed scope of practice in head and neck cancers (ACSQHC 2015). It is also necessary for the radiation oncologist to have ongoing and regular attendance at and a commitment to MDMs and continuing professional development in head and neck oncology.

The training and experience of the radiation oncologist should be documented.

Health service unit characteristics

To provide safe and quality care for patients having radiation therapy, health services should have these features:

  • linear accelerator (LINAC) capable of image-guided radiation therapy (IGRT)
  • dedicated CT planning
  • access to MRI and PET imaging
  • automatic record-verify of all radiation treatments delivered
  • a treatment planning system
  • trained medical physicists, radiation therapists and nurses with radiation therapy experience
  • nurses, dietitians, dentists, speech pathologists and social workers with training and current experience in managing patients with head and neck cancer
  • on-site or an existing relationship with specialist dental services before fitting a treatment mask
  • head and neck cancer–specific peer review
  • a clearly defined path to emergency care and advice after hours
  • a clearly defined path and assured access to inpatient care
  • coordination for combined therapy with systemic therapy, especially where facilities are not co-located
  • participation in Australian Clinical Dosimetry Service audits
  • an incident management system linked with a quality management system.