Managing Side Effects of Nasopharyngeal Cancer Treatment: Key Considerations

Radiation therapy for nasopharyngeal carcinoma is reduced?

My father was diagnosed with stage IV nasopharyngeal carcinoma, but there was no distant metastasis; however, there was involvement of the lymph nodes in the head and neck region and the left optic nerve.
Initially, he underwent 9 weeks of chemotherapy, and post-chemotherapy MRI results indicated that the cancer cells had decreased by approximately 60%.
He is currently undergoing a 7-week course of radiation therapy (5 days a week) combined with chemotherapy (1 day a week), and he has completed 3 weeks.
However, due to the extensive radiation field, he has started to experience vision deterioration, weakness, loss of appetite, bleeding from the gums where he has dentures on the left side, and difficulty chewing.
He has purchased liquid nutritional supplements but is unable to consume them, and his weight has decreased (from 70.9 kg to 69.5 kg this week).
He has begun to express resistance to continuing radiation therapy.
The doctor mentioned that approximately 20% of cancer cells remain, and I would like to understand the potential consequences of stopping radiation therapy at this point.
If we were to reduce the frequency of the remaining 4 weeks of radiation therapy to extend it to 6 weeks, would that help alleviate the side effects? He has always believed that Western medical treatments kill both good and bad cells and is interested in using traditional Chinese medicine for conditioning.
Is it appropriate to pursue this during the ongoing radiation and chemotherapy treatment?

Ai Jie, 20~29 year old female. Ask Date: 2022/06/11

Dr. Chen Sirong reply Oncology

1.
What are the consequences of stopping radiation therapy? A: The tumor may grow and compress the optic nerve, potentially leading to blindness in the left eye.
It could invade the brain, nose, and lymph nodes in the neck, causing recurrence and growth that may lead to skin ulceration, bleeding, and pus formation.
There is also a possibility of metastasis to the liver, lungs, and bones, resulting in various uncomfortable symptoms.
2.
If the remaining 4 weeks of radiation therapy are reduced in frequency and extended to 6 weeks, will it improve side effects? A: The effectiveness will decrease; it will not completely eradicate the cancer.
It is akin to setting a timed bomb within oneself.
3.
Is it appropriate to use traditional Chinese medicine for conditioning during this period of radiation and chemotherapy? A: Conditioning is not a treatment for cancer.
Both therapies can be conducted concurrently, but it is crucial to adhere to radiation therapy.
Pain relief can be managed with morphine daily, and nutritional support through IV fluids can be considered.
Hospitalization for treatment may also be an option.
Wishing for a speedy recovery.
Taoyuan Hospital, Dr.
Chen Si-Rong.

Reply Date: 2022/06/11

More Info

Managing the side effects of nasopharyngeal cancer treatment, particularly in advanced stages, is a critical aspect of care that requires a multifaceted approach. Your father's situation, having been diagnosed with stage IV nasopharyngeal cancer and undergoing a combination of chemotherapy and radiation therapy, presents several challenges, particularly with the side effects he is experiencing.

1. Consequences of Stopping Radiation Therapy
If your father decides to stop radiation therapy at this point, there are significant risks involved. The primary concern is that the remaining cancer cells could continue to grow and potentially lead to a recurrence of the disease. Stopping treatment prematurely may allow the tumor to regain strength, which could result in further complications, including pressure on surrounding structures such as the optic nerve, which could lead to vision loss. Additionally, there is a risk of metastasis, where cancer cells could spread to other parts of the body, leading to more severe health issues.

2. Adjusting Radiation Therapy Schedule
Extending the duration of radiation therapy while reducing the frequency of treatments may seem like a way to alleviate side effects; however, it could compromise the effectiveness of the treatment. Radiation therapy is designed to be delivered in a specific regimen to maximize its impact on cancer cells while minimizing damage to surrounding healthy tissue. Altering this schedule could lead to suboptimal treatment outcomes, potentially allowing the cancer to progress. It’s crucial to discuss any changes to the treatment plan with the oncologist, who can provide guidance based on the latest clinical evidence and your father's specific situation.

3. Integrating Traditional Chinese Medicine (TCM)
Your father's interest in using Traditional Chinese Medicine (TCM) during his treatment is understandable, especially given the side effects he is experiencing. While TCM can provide supportive care, such as herbal remedies and acupuncture, it is essential to approach this integration cautiously. Some herbal treatments may interact with conventional cancer therapies, potentially reducing their effectiveness or exacerbating side effects. It is vital to consult with both his oncologist and a qualified TCM practitioner to ensure that any complementary therapies are safe and appropriate.

4. Managing Side Effects
Given the side effects your father is experiencing, including vision changes, weakness, and difficulty eating, several strategies can help manage these issues:
- Nutritional Support: Since he is struggling to consume solid foods, consider consulting a nutritionist who specializes in oncology. They can recommend high-calorie, nutrient-dense liquid supplements that are easier to consume. Options like protein shakes or specialized nutritional drinks can help maintain his weight and strength.

- Pain Management: For oral pain and discomfort, medications such as topical anesthetics or systemic pain relievers may be necessary. Discussing these options with his healthcare team can help improve his quality of life.

- Oral Care: Maintaining good oral hygiene is crucial, especially when undergoing radiation therapy. Using a gentle mouthwash, avoiding irritants, and possibly using medicated mouth rinses can help alleviate oral mucositis and bleeding gums.

- Regular Monitoring: Frequent follow-ups with his healthcare team are essential to monitor his response to treatment and manage side effects proactively. This includes regular assessments of his nutritional status, pain levels, and overall well-being.

Conclusion
In summary, while the side effects of nasopharyngeal cancer treatment can be challenging, it is crucial to adhere to the prescribed treatment plan to maximize the chances of a favorable outcome. Open communication with the healthcare team about any concerns, including the desire to incorporate TCM, is essential. By addressing side effects through nutritional support, pain management, and regular monitoring, your father can better navigate this difficult period in his cancer journey.

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