• Radiation Therapy for Esophageal Cancer

    Radiation therapy uses high energy x-rays to destroy cancer cells. Special tools and dosing will help to kill as much of the cancer as possible while minimizing the effect on nearby healthy tissue. A radiation oncologist will customize the treatment dose for individual needs.
    For esophageal cancer, radiation therapy is most often used in combination with chemotherapy (called chemoradiation). The combination of chemotherapy and radiation is more effective in shrinking the esophageal tumor and extending life than either treatment alone.
    Radiation therapy may also be given:
    • Before surgery to shrink the tumor and minimize the amount of tissue that has to be removed
    • After surgery to kill any remaining cancerous tissue
    • For metastatic cancer to relieve symptoms and extend survival time
    Types of radiation therapy used for esophageal cancer:

    External Beam Radiation

    In external beam radiation therapy, a machine directs high-energy rays through the body and into the tumor. There are many different radiation machines used for external radiation therapy based on the size of the tumor, surrounding tissue, and type of cancer. The radiation oncologist will discuss options, doses, and frequency of radiation so that the highest amount of radiation can be delivered to the cancer with as little impact on healthy tissue as possible.
    The therapy is often delivered in a number of doses over a few weeks on an outpatient basis.

    Brachytherapy

    This is also called internal radiation therapy. Radioactive material in a specialized container is placed near the tumor. This allows a higher dose of radiation to be delivered directly to the tumor. It is generally used to treat tumors that are obstructing the esophagus. The material is placed during an endoscopy, a procedure that threads a lighted tube into the mouth and down the throat to the tumor site. Brachytherapy may be:
    • Low-dose—Radiation is left in place for 1-2 days. A hospital stay is required, but it can be one in 1-2 cycles.
    • High-dose—Radiation is left in for a few minutes at a time. Because of this, more cycles are required.

    Side Effects and Management

    Complications of radiation therapy to the chest and abdominal areas may include:
    • Difficulty or pain when swallowing
    • Narrowing of the esophagus—esophageal stricture
    • An abnormal opening between 2 structures—fistula
    • Lung damage
    • Shortness of breath
    A variety of treatments are available to help manage side effects of radiation therapy, such as dry, irritated skin, nausea, vomiting, diarrhea, and fatigue due to anemia. Sometimes adjustments to treatment doses may also be possible. The earlier side effects are addressed, the more likely they will be controlled with a minimum of discomfort.

    References

    Esophageal and esophagogastric junction cancer. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed. Updated August 10, 2015. Accessed December 17, 2015.

    Esophageal cancer. Merck Manual Professional Version website. Available at: http://www.merckmanuals.com/professional/gastrointestinal-disorders/tumors-of-the-gi-tract/esophageal-cancer. Updated July 2014. Accessed December 17, 2015.

    Esophagus cancer. American Cancer Society website. Available at http://www.cancer.org/acs/groups/cid/documents/webcontent/003098-pdf.pdf. Accessed December 17, 2015.

    Treatment option overview. National Cancer Institute website. Available at: http://www.cancer.gov/types/esophageal/patient/esophageal-treatment-pdq#section/%5F159. Updated December 17, 2015. Accessed December 17, 2015.

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