Radiation therapy entails the use of high-energy radiation to destroy cancer cells. There are two types of radiation therapy. In external beam radiation therapy, the radiation is focused on the cancer from a source outside the body. External beam radiotherapy is the most commonly used radiation treatment modality for esophageal cancer. Brachytherapy, or internal beam radiation therapy, involves using of highly radioactive material to treat cancer. For patients with esophageal cancer, catheters with radioactive beads are placed directly inside the esophagus, close to the cancer, so high energy radiation can be delivered directly to the cancerous area without affecting the surrounding normal tissues. Several clinical trials have demonstrated that brachytherapy in esophageal cancer management is often related to severe side effects and complications. Therefore, brachytherapy should not be used as the primary treatment option for esophageal cancer.
Radiation therapy is considered the primary treatment for esophageal cancer in cases where the patient cannot undergo surgery. For those who do undergo surgery, radiation therapy can be used to destroy those tiny cancer cell deposits that were left in the body despite the surgery. Physicians commonly prescribe 50.4 Gy (Gray) of radiation delivered over 28 fractions. For curative treatment, radiation is usually given with concurrent chemotherapy, which is often delivered via intravenous infusion.
For patients with incurable esophageal cancer, radiation therapy can be used to ease symptoms of the disease. Common symptoms caused by esophageal cancer include obstruction of the esophagus, bleeding from the tumor, difficulty swallowing and cancer pain. Radiotherapy is also used to palliate symptoms related with the spread of the disease to the brain. Although radiation therapy usually cannot cure esophageal cancer by itself, and is usually combined with surgery and/or chemotherapy, it is an effective palliative treatment modality. For example, more than 70% of patients with difficulty swallowing due to obstruction or pain caused by esophageal cancer feel some temporary relief from 4 to 5 weeks of external beam radiotherapy.
Although radiation is an effective therapeutic modality for treating esophageal cancer, it also causes few side effects. Skin reaction, nausea, vomiting, discomfort during swallowing, fatigue, and diarrhea may occur. Radiation therapy directed at the chest could damage the lungs and lead to shortness of breath and cough. The side effects of chemotherapy could also be exacerbated by radiation therapy.
Patients undergoing radiation therapy should inform their cancer care team of these side effects, should they occur, so that they may be managed properly.
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Reviewed by:
Jiade J. Lu, M.D.
Diplomate, American Board of Radiology (Radiation Oncology)
Medical Director
The Cancer Information Network
Date Modified: 06/10/04
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