Radiation Therapy for Esophageal Cancer
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Radiation therapy is the use of penetrating beams of high-energy waves or streams of particles called radiation to treat disease. Radiation therapy destroys the ability of cancer cells to grow and divide.
Radiation does not cure esophageal cancer (or most other types of cancer), but it does offer temporary relief of symptoms and in some cases shrinkage of the tumor. Radiation used in conjunction with chemotherapy and sometimes followed by esophagectomy may offer improved survival over any method used alone.
Type of Radiation Therapy Used for Esophageal Cancer
Both external and internally placed radiation sources are used to treat esophageal cancer. In external radiation therapy, rays are directed at the tumor from outside the body. Internal radiation therapy, also called brachytherapy, places the radiation source as close as possible to the cancer cells. Radioactive material, sealed in a thin wire, catheter, or tube, is placed directly into the affected tissue.
Radiation therapy may be offered to you as part of your initial treatment either with or without chemotherapy. The addition of chemotherapy may depend on the size of your tumor, extent of spread, overall condition, and your wishes. In general, external beam radiation is used first, and brachytherapy is used later on, if the tumor starts to grow again. Brachytherapy does not penetrate very deeply, so it may only be helpful for superficial recurrences or to help reopen a re-obstructed esophagus.
Radiation therapy, without chemotherapy, does not significantly impact survival. The addition of chemotherapy results in a higher response (shrinkage of tumor) and survival. In one major study, the survival of patients receiving only radiation was 8.9 months, compared to 12.5 months in those receiving both chemotherapy and radiation. The 2-years survival rate for patients randomized to combined chemotherapy and radiation was 38%, compared with 10% for those randomized to radiation alone.
Side Effects and Possible Complications
In addition to the general side effects of radiation, this treatment will tend to constrict the esophagus further over time. To prevent that, a tube may be inserted into the esophagus during treatment.
Casciato DA. Manual of Clinical Oncology. 5th ed. Philadelphia, PA: Lippincott Williams & Wilkins; 2004
Esophageal cancer. National Cancer Institute website. Available at: http://www.nci.nih.gov/cancerinfo/wyntk/esophagus . Accessed December 2, 2002.
Harrison's Principles of Internal Medicine. 14th ed. McGraw-Hill; 1998.
Neoplasms of the esophagus. American Cancer Society website. Available at http://www.cancer.org/docroot/home/index.asp . Accessed November 30, 2002.
Last reviewed July 2007 by Mohei Abouzied, MD
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