Esophageal Cancer: Radiation Therapy
What is radiation therapy?
Radiation therapy uses high-energy radiation from X-rays or particles to kill cancer cells.
When might radiation therapy be used?
Radiation is often part of the treatment for esophageal cancer. There are several reasons your healthcare provider may suggest this treatment:
As part of the main treatment for early stage esophageal cancer. It can be used along with chemotherapy (chemo) to treat some cancers. This may be done instead of surgery.
To try to shrink a cancer before surgery. Radiation with chemo may make it easier to remove the cancer. This might reduce the amount of surgery needed. When it’s used before surgery, it’s called a neoadjuvant therapy.
To try to kill any cancer cells left after surgery. When radiation is used after surgery, it’s called an adjuvant therapy. This may be used (often with chemo) if your healthcare provider is not sure all the cancer cells were removed.
To ease symptoms caused by tumors that can't be treated with surgery or that have spread to other organs.
To plan your treatment, you'll meet with a team of cancer specialists. This might include a surgeon, radiation oncologist, and medical oncologist.
What happens during radiation therapy
A doctor who specializes in cancer and radiation is called a radiation oncologist. This doctor works with you to decide the kind of radiation you need. This doctor also determines the dose and how long you need the treatment.
There are two types of radiation that can be used to treat esophageal cancer: external and internal radiation.
The most common way to receive radiation for esophageal cancer is from a machine outside your body. This focuses beams of radiation at the cancer. This is called external radiation. Sometimes special types of external radiation, such as intensity-modulated radiation therapy (IMRT), are used. This is done to try to limit the doses of radiation reaching nearby normal cells.
You can normally receive external radiation on an outpatient basis (where you go home the same day) in a hospital or a clinic. External radiation is usually given for five days a week for several weeks.
Preparing for radiation
Before your first radiation treatment, you’ll have an appointment. This is done to find exactly where on your body the radiation beam needs to be directed. The process is called simulation. It may take up to two hours. During this session, you may have imaging tests. These can include CT scans or MRI scans. These tests can help your healthcare providers know the exact location of your tumor to better aim the radiation. Also at this session, you may have body molds made to help keep you from moving during the treatment. Then, you’ll lie still on a table while a radiation therapist uses a machine to define your treatment field. The field is the exact area on your body where the radiation will be aimed. Sometimes it’s called your port. The therapist may mark your skin with tiny dots of semi-permanent ink. This is so the radiation will be aimed at the exact same place each time.
On the days you get radiation
On the days you get treatment, you’ll lie on a table while the machine is placed over you. You may have to wear a hospital gown. It’s like getting an X-ray, only longer. It takes about 15 to 30 minutes to do. You should, though, plan on being there for about an hour.
At the start of the treatment session, a radiation therapist may place blocks or special shields to protect parts of your body from exposure to radiation. The therapist then lines up the machine so that radiation is directed to the spot that was marked. When you’re ready, the therapist leaves the room and turns the machine on. You may hear whirring or clicking noises during radiation. This may sound like a vacuum cleaner. During the session, you’ll be able to talk to the therapist over an intercom. You can’t feel radiation, so the process will be painless. Also, you will not be radioactive afterward.
Internal radiation (brachytherapy)
In this approach, a long, thin tube is passed down your throat to put a small radiation source right next to the cancer. The radiation travels only a short distance. So, it affects mainly just cancer cells. Because the radiation travels only a short distance, it can't be used to treat large tumors. This treatment can be used to help relieve symptoms, such as if a tumor is making it hard to swallow. But it’s not normally used as part of treatment when the goal is to cure the cancer.
Preparing for radiation
To prepare for your treatment, you’ll have an appointment for some imaging tests. These may include a CT scan and esophageal ultrasound. This helps your healthcare provider see your esophagus and surrounding area. That way, he or she can map out exactly where the radiation needs to be placed.
On the days you get radiation
You can receive this treatment in either in a hospital or outpatient setting. On the day of the procedure, you may have a local anesthetic or general anesthesia so you fall asleep and don’t feel pain. While you lie on your back, your healthcare provider puts a tube down your throat and into your esophagus. He or she then carefully guides the radiation source down the tube near the cancer. This allows your healthcare provider to give the radiation. The treatment may be given over a few minutes. It might need to be repeated at a later time. Or the radiation may be left in place for a day or so. In this case, you’ll need to stay in the hospital.
What to expect after radiation therapy
Because radiation affects normal cells as well as cancer cells, you may have some side effects. The side effects from radiation are normally limited to the area being treated. Some people have few or no side effects. If you do have them, your healthcare provider may change the dose of your radiation or the how often you receive treatment. Or he or she may stop your treatment until your side effects clear up. Tell your healthcare provider about any side effects you have.
Potential side effects
Common side effects can include:
Skin irritation or changes in the areas on your skin that get radiation
Swelling in your neck or chest
Mouth or throat sores
Burning, tightness, or pain when swallowing and eating
Dry mouth and throat, or thick saliva
Nausea or vomiting
If you have any of these side effects, talk with your healthcare provider about how to deal with them. You should also ask what to do if your side effects become serious. Most of these side effects tend to go away a few weeks after you stop treatment.
March 21, 2017
Management of Locally Advanced Unresectable and Inoperable Esophageal Cancer. UpToDate.
Alteri, Rick, MD,Gersten, Todd, MD