Radiation Therapy for Esophageal Cancer

Radiation therapy uses high-energy rays (such as x-rays) or particles to destroy cancer cells. When treating esophageal cancer, radiation is often combined with other types of treatment, such as chemotherapy (chemo) and/or surgery.

Chemotherapy can make radiation therapy more effective against some esophageal cancers. Using these treatments together is called chemoradiation.

When is radiation therapy used for esophageal cancer?

Radiation therapy might be used:

• As part of the main treatment in some people, typically along with chemo (chemoradiation). This is often used for people who can’t have surgery due to poor health or who don’t want surgery.
• Before surgery (and along with chemo when possible), to try to shrink the cancer and make it easier to remove. This is called neoadjuvant treatment.
• After surgery (and along with chemo when possible), to try to kill any 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 supportive or palliative therapy.

Types of radiation therapy

There are 2 main types of radiation therapy used to treat esophageal cancer.

External beam radiation therapy (EBRT)

This is the type of radiation therapy used most often for people with esophageal cancer.

Each treatment uses a machine that targets radiation to the cancer. It is much like getting an x-ray, although the radiation dose is stronger. The treatment itself is painless and typically lasts only a few minutes, although the setup time – getting you into place for treatment – takes longer.

How often and how long you get radiation therapy depends on the reason it’s being given and other factors. It can last anywhere from a few days to weeks.

Modern EBRT techniques, such as intensity-modulated radiation therapy (IMRT) and proton beam therapy, can often target tumors more precisely than older techniques, so they might be used to treat esophageal cancer, especially at larger medical centers. To learn more about these types of radiation therapy, see Getting External Beam Radiation Therapy.

Internal radiation therapy (brachytherapy)

For this type of radiation therapy, the doctor passes an endoscope (a long, flexible tube) down the throat to place radioactive material very close to the cancer. The radiation travels only a short distance, so it reaches the tumor but has little effect on nearby normal tissues. This usually causes fewer side effects than external beam radiation. The radioactive source is removed a short time later.

Brachytherapy is not used often to treat esophageal cancer, but it might be helpful with more advanced esophageal cancers to shrink tumors to help a person swallow more easily. This technique cannot be used to treat a very large area, so it is better used to help relieve symptoms (and not to try to cure the cancer).

Brachytherapy can be given 2 ways:

• For high dose rate (HDR) brachytherapy, the doctor leaves the radioactive material near the tumor for only 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.

A person typically needs to stay in the hospital during this treatment.

Side effects of radiation therapy

If you are going to get radiation therapy, it’s important to ask your doctor beforehand about the possible side effects so you know what to expect.

Possible side effects of radiation therapy can include:

• Skin changes similar to a sunburn in areas getting radiation, which can range from redness to blistering and peeling
• Nausea and vomiting
• Diarrhea
• Fatigue
• Painful sores in the mouth and throat
• Dry mouth or thick saliva (spit)
• Pain when swallowing

Most side effects of radiation go away after treatment, but some might not. For example:

• In some people, radiation can cause a stricture (narrowing) in the esophagus, which might require more treatment.
• Radiation might cause a tracheoesophageal fistula to form. This is a connection between the esophagus and the trachea (windpipe), which sits right in front of it. Swallowed food or liquids can then pass from the esophagus into the windpipe and lungs, which can lead to coughing, gagging, or even pneumonia.
• Radiation to the chest can cause lung damage, which may lead to problems breathing and shortness of breath.

If you notice any side effects, talk to your doctor right away so they can be managed.