Radiation therapy can be an integral part of the treatment of esophageal cancer. However, since esophageal cancer is not exclusively treated with radiation therapy, it is important for patients to be treated in an environment that can offer multi-modality treatment involving radiation oncologists, surgeons, gastroenterologists, medical oncologists and nutritionists.

The objective of radiation therapy to the esophagus is to kill cancer cells that could otherwise persist after therapy and cause the cancer to relapse locally. Radiation therapy uses high energy x-rays to kill cancer cells that remain in or near the esophagus and surrounding lymph nodes. Radiation therapy can be externally or internally delivered to the esophagus and surrounding lymph nodes. External beam radiation therapy (EBRT) delivers radiation from a machine outside the body, called a linear accelerator. EBRT treatments are typically delivered 5 days a week, for 2-6 weeks, depending on the overall goals of treatment and each treatment lasts between 10-15 minutes. The internal delivery of radiation therapy (brachytherapy) involves the placement of a radioactive isotope, such as iridium 192, within the esophagus.

Primary Treatment with Radiation Therapy

External beam radiation therapy alone is not usually recommended for primary treatment of esophageal cancer because radiation administered in combination with chemotherapy improves survival compared to treatment with radiation alone.

The results of radiation therapy and chemotherapy as primary treatment for esophageal cancer are presented under the treatment overviews for each stage of esophageal cancer. In general, current evidence suggests that combined chemotherapy and radiation therapy is superior to either therapy alone as primary therapy for esophageal cancer.

However, radiation therapy alone can be used to treat localized cancer in patients who cannot tolerate surgery or chemotherapy. Treatment with radiation therapy alone results in an approximate18% survival at one year, an 8% survival at two years and less than 5% survival at 5 years in patients with localized esophageal cancer (stage I-III).

Radiation therapy alone can also be used to decrease the symptoms from esophageal cancer in patients with more advanced disease who are medically unable to receive surgery or chemotherapy or for patients who have a recurrence after surgery. However, patients with locally recurrent cancer usually receive simultaneous chemotherapy.

Side Effects of Radiation Therapy

Radiation therapy may produce considerable short-term side effects such as mucositis (inflammation of the lining of the throat, mouth and esophagus), perforation of the esophagus with the development of fistulas (connections with other organs such as the trachea), infection, bleeding, xerostomia (dryness in the mouth) and fatigue. Changes to the esophagus and skin usually go away in 6-12 months. Some patients who respond to radiation therapy will develop strictures or narrowing of the esophagus that will require treatment in the future.

Strategies to Improve Treatment

The progress that has been made in the treatment of esophageal cancer has resulted from improved development of adjuvant treatments and doctor and patient participation in clinical studies. Future progress in the treatment of esophageal cancer will result from continued participation in appropriate studies. Currently, there are several areas of active exploration aimed at improving the treatment of esophageal cancer.