Radiation Therapy for Esophageal Cancer

Radiation therapy uses high-energy rays (such as x-rays) or particles to destroy cancer cells. It is often combined with other types of treatment, such as chemotherapy (chemo) and/or surgery, to treat esophageal cancer. Chemotherapy can make radiation therapy more effective against some esophagus cancers. Using these 2 treatments together is called chemoradiation.

When is radiation therapy used for esophagus cancer?

Radiation therapy may be used:

• As part of the main treatment of esophageal cancer in some patients, typically along with chemo (chemoradiation). This is often used for people who can’t have surgery due to poor health or for people 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 palliative therapy.

Types of radiation therapy

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

External-beam radiation therapy (EBRT) is the type of radiation therapy used most often for people with esophageal cancer. The radiation is focused on the cancer from a machine outside the body. It is much like getting an x-ray, but the radiation is more intense. How often and how long the radiation treatments are delivered depends on the reason the radiation is being given and other factors. It can last anywhere from a few days to weeks.

Internal radiation therapy (brachytherapy) is a type of radiation where 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 means fewer side effects than with external beam radiation. The radioactive source is removed a short time later.

Brachytherapy is not used often to treat esophageal cancer, but might be helpful 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).

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. The patient needs to stay in the hospital during this treatment, but it can usually be completed in only 1 or 2 sessions.

Other types of radiation, such as IMRT (a type of EBRT) as well as proton therapy, are being studied to treat esophageal cancer.

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 external radiation therapy can include:

• Skin changes in areas getting radiation, such as redness, blistering and peeling
• Nausea and vomiting
• Diarrhea
• Fatigue
• Painful sores in the mouth and throat
• Dry mouth or thick saliva (spit)
• Pain with swallowing

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

Most side effects of radiation are temporary, but some less common side effects can be permanent. For example, in some cases radiation can cause a stricture (narrowing) in the esophagus, which might require more treatment. 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 steps can be taken to lessen them.