Oropharyngeal Cancer Timeline: Radiation Alone

Radiation alone, given 5 days a week for about 7 weeks, is an option for many small, early oropharyngeal cancers. In studies, survival is similar to surgery, with a different set of side effects.

This page is one of six treatment-track timelines for oropharyngeal cancer. The steps before treatment, how a track is chosen and the long-term follow-up schedule are covered on the oropharyngeal cancer treatment timelines page.

Who follows this track

Radiation alone is most often used for small, early cancers with no or few involved lymph nodes, HPV-positive or HPV-negative. Surgery alone is the main alternative for many of these cancers. The choice between them often comes down to the tumor's location, the person's overall health, and which set of side effects fits the person's life better. For larger or more advanced cancers, chemotherapy is usually added, which is the chemoradiation track.

Before radiation (weeks 0 to 4)

The biopsy, scans, p16 (HPV) result, meetings with the care team, dental check, baseline swallow test, dietitian visit and the tumor board's recommendation are described on the overview page. The dental check matters especially on this track: teeth in poor condition in the radiation field are usually removed at least 2 weeks before radiation starts.

Radiation (about weeks 5 to 12)

• Radiation is given 5 days a week for about 7 weeks. A typical full dose is 70 Gray (Gy).

• Each visit is short. A fitted mask holds the head still so the beams reach the same spot every day.

• Modern targeted radiation shapes the dose around the tumor and lymph nodes to spare nearby saliva glands and swallowing muscles as much as possible.

Side effects and healing

Side effects build gradually over the 7 weeks, are usually at their worst in the last week or two of treatment and the 1 to 2 weeks after it ends, and then slowly improve.

• Sore mouth and throat (mucositis): starts around week 2 of radiation, peaks near the end, and usually heals within 3 to 4 weeks after treatment ends.

• Swallowing and taste: swallowing trouble peaks late in treatment and improves mostly over the following 6 to 12 months. Taste changes begin a few weeks in, and most taste returns over 3 to 12 months, though some changes can linger.

• Dry mouth: begins early and often partly recovers over 1 to 2 years, though some dryness can last.

• Weight loss and tiredness are common. A temporary feeding tube is needed by some people.

• Recovery: energy and eating improve over the 3 to 6 months after radiation, with continued gains up to a year.

Check-ups and scans

• The follow-up clock starts at the end of radiation, about week 12.

• A PET-CT scan about 12 weeks after radiation checks whether treatment worked. A clear scan at 3 months is very reassuring; scans earlier than 12 weeks can give false alarms from healing inflammation.

• Check-ups then follow the usual schedule: every 1 to 3 months in the first year, every 2 to 6 months in the second, every 4 to 8 months in years 3 to 5, then yearly.

Quality of life on this track

Average scores before and after treatment (0 to 100; swallowing 20 to 100; higher is better):

• Overall: 82 before treatment, 76 at 1 year and 82 at 3 years.

• Swallowing: 87 before, 82 at 3 to 6 months and 82 at about 2 years.

• Speech: 95 before, 94 at 1 year and 91 at 3 years.

• Mood: 79 before, 88 at 1 year and 86 at 3 years. Mood often improves once treatment is over.

These studies did not measure scores in the weeks right after radiation, when side effects peak. The chemoradiation timeline shows how much scores typically dip at the end of radiation-based treatment and how they recover.

Where the numbers come from: the overall, speech and mood scores come from the radiation group of a randomized study that compared radiation with surgery for early oropharyngeal cancer. Most people in that group also received chemotherapy with radiation, so these scores may run slightly lower than for radiation alone. The swallowing scores come from a large study that reported radiation alone separately. The questionnaires are described on the quality-of-life questionnaires page.

Long-term care

• Dental visits and possible fluoride treatments continue for life, because of the jaw-healing risk after radiation (osteoradionecrosis).

• A thyroid blood test (TSH) every 6 to 12 months for 3 years checks for hypothyroidism, which radiation to the neck can cause.

• Swallowing exercises and periodic checks continue, and staying tobacco-free lowers the risk of the cancer returning or a new cancer.