Radiation therapy for cancer of the esophagus

Radiation therapy is the use of high-energy radiation to kill cancer cells. It is often combined with other types of treatment, such as chemotherapy (chemo) and/or surgery, to treat esophageal cancer. Radiation therapy may be used:

• As part of the primary (main) treatment of esophageal cancer in some patients, typically along with chemo. This is often used for people who can't have surgery due to poor health.
• Before surgery (usually along with chemo), to try to shrink the cancer and make it easier to remove (called neoadjuvant treatment).
• After surgery (usually along with chemo), to try to kill any areas of cancer cells that may have been left behind but are too small to see. This is known as adjuvant therapy.
• To ease the symptoms of advanced esophageal cancer such as pain, bleeding, or trouble swallowing. This is called palliative therapy.

There are 2 main types of radiation therapy.

External-beam radiation therapy: This type of treatment focuses radiation from outside the body on the cancer. This is the type of radiation therapy most often used when the intent is to try to cure esophageal cancer.

Before your treatments start, the radiation team will take careful measurements to determine the correct angles for aiming the radiation beams and the proper dose of radiation. Radiation therapy is much like getting an x-ray, but the radiation is stronger. The procedure itself is painless. Each treatment lasts only a few minutes, although the setup time – getting you into place for treatment – usually takes longer. Most often, radiation treatments are given 5 days a week for several weeks.

Internal radiation therapy (brachytherapy): For this type of treatment, the doctor places radioactive material very close to the cancer through an endoscope. The radiation travels only a short distance, so it reaches the tumor but has little effect on nearby normal tissues. The radioactive source is then removed a short time later. Brachytherapy can be given 2 ways:

For high-dose rate (HDR) brachytherapy, the doctor leaves the radioactive material near the tumor for a few minutes at a time, which may require several treatments.

In low-dose rate (LDR) brachytherapy, a lower dose of radiation is put near the tumor for longer periods (1 or 2 days) at a time. This requires that the patient stay in the hospital during treatment, but it can usually be completed in only 1 or 2 treatments.

Brachytherapy is most often used with more advanced esophageal cancers to shrink tumors so a patient can swallow more easily. This technique cannot be used to treat a very large area, so it is better used as a way to relieve symptoms (and not to try to cure the cancer).

Possible side effects of radiation therapy

Side effects of external radiation therapy may include:

• Skin changes ranging from sunburn-like to blistering and open sores
• Nausea and vomiting
• Diarrhea
• Fatigue
• Painful sores in the mouth and throat
• Dry mouth or thick saliva

These side effects are often worse if chemotherapy is given at the same time as radiation.

During treatment with either external radiation or brachytherapy, the radiation kills the normal cells in the lining of the esophagus, which can lead to painful swallowing. This starts shortly after beginning treatment but typically improves within a few weeks of finishing.

Most side effects of radiation are temporary, but some rare serious side effects can be permanent. For example, in some cases radiation can cause a stricture (narrowing) in the esophagus, which may require further treatment. Radiation to the chest can also cause lung damage, which may lead to problems breathing and shortness of breath.

Talk with your doctor before and during treatment about what side effects you can expect and any ways that they could be reduced.