Radiation therapy for esophageal cancer

Radiation therapy uses high-energy rays or particles to destroy cancer cells. Most people with esophageal cancer have radiation therapy. Your healthcare team will consider your personal needs to plan the type and amount of radiation, and when and how it is given. You may also receive other treatments.

Radiation therapy is most often combined with chemotherapy to treat esophageal cancer. This is called chemoradiation. The 2 treatments are given during the same time period. Chemotherapy can make radiation therapy more effective in treating esophageal cancer.

Radiation therapy is given for different reasons. You may have radiation therapy or chemoradiation to:

• shrink a tumour before surgery (called neoadjuvant therapy)
• destroy cancer cells left behind after surgery to reduce the risk that the cancer will come back (recur) (called adjuvant therapy)
• treat esophageal cancer in people who can't have surgery, or don't want to have surgery
• relieve pain or control the symptoms of advanced esophageal cancer (called palliative therapy)

The following types of radiation therapy are most commonly used to treat esophageal cancer.

During external radiation therapy, a machine directs radiation through the skin to the tumour and some of the tissue around it.

External radiation therapy is the most common type of radiation therapy used for people with esophageal cancer. It is usually given 5 times per week for several weeks.

Your healthcare team will very carefully plan radiation therapy for esophageal cancer. Several organs close to the esophagus can be damaged by radiation, including the liver, kidneys, lungs, spinal cord and heart. Special shields are made and used during external radiation therapy to protect other organs in the area as much as possible.

Brachytherapy is internal radiation therapy. It uses a radioactive material called a radioactive isotope. Iridium is the most common radioactive isotope used in brachytherapy. It is placed right into the tumour or very close to it. Radioactive materials can also be placed in the area from where the tumour was removed. The radiation kills the cancer cells over time.

Brachytherapy is often used in combination with external beam radiation therapy for esophageal cancer. The brachytherapy gives a boost of additional radiation. It may be given before or after external beam radiation therapy.

Brachytherapy may also be used as a palliative treatment to slow the growth of or shrink the tumour, which can make it easier to swallow or stop bleeding.

Intraluminal brachytherapy places the radioactive implant inside the esophagus next to the tumour. It may be placed using an endoscope or a nasogastric (NG) tube.

Brachytherapy for esophageal cancer is given in low-dose or high-dose rates:

Low-dose rate (LDR) therapy delivers continuous, low doses of radiation over time (usually a few days). If you are being given LDR therapy you usually have to stay in the hospital and follow special radiation safety precautions to protect others. Your healthcare team will provide instructions and information about any safety precautions you need to follow and for how long. Talk to them if you have any safety concerns or questions.

High-dose rate (HDR) therapy delivers a single, high dose of radiation in a very short period of time. A single treatment usually takes a few minutes and you don't need to stay in the hospital

Side effects can happen with any type of treatment for esophageal cancer, but everyone's experience is different. Some people have many side effects. Other people have few or none at all.

During radiation therapy, the healthcare team protects healthy cells in the treatment area as much as possible. But damage to healthy cells can happen and may cause side effects. If you develop side effects, they can happen any time during, immediately after or a few days or weeks after radiation therapy. Sometimes late side effects develop months or years after radiation therapy. Most side effects go away on their own or can be treated, but some side effects may last a long time or become permanent.

Side effects of radiation therapy will depend mainly on the size of the area being treated, the specific area or organs being treated, the total dose of radiation, the treatment schedule and whether or not chemotherapy is given during the same time period as radiation therapy.

Some common side effects of radiation therapy used for esophageal cancer are:

• fatigue
• skin problems
• nausea and vomiting
• dry mouth
• difficulty swallowing
• sore mouth and throat
• diarrhea
• loss of appetite
• lung problems
• narrowing of the esophagus (called a stricture)
• abnormal opening between the esophagus and trachea (called a fistula)

Tell your healthcare team if you have these side effects or others you think might be from radiation therapy. The sooner you tell them of any problems, the sooner they can suggest ways to help you deal with them.

Find out more about radiation therapy. To make the decisions that are right for you, ask your healthcare team questions about radiation therapy.