Esophageal Cancer

RADIATION THERAPY

Typical Course

Some patients receive radiation therapy as the primary mode of treatment. In this case, relatively high doses of radiation are given. A typical course of treatment will consist of approximately 65-70 gray administered in approximately 40 individual treatments, five days a week over an eight-week period. Radiation treatment usually is given from several different directions, front and back as well as sides. The treatment is directed at the visible tumor as well as adjacent tissue where microscopic cancerous deposits may be hiding.

In patients who receive radiation in conjunction with surgery, treatment can be given either before or after the major radiation. Preoperative radiation therapy offers the advantage that the tumor may shrink and make the surgery easier. Postoperative radiation therapy offers the advantage that the radiation fields can be constructed more carefully, based on the knowledge obtained by the surgeon. Thus, the pluses and minuses of the two approaches have to be considered for each individual patient.

Radiation given adjuvant to surgery is typically in a lower dose, 50 to 55 gray in 30 treatments over six weeks.

Chemotherapy is frequently administered in conjunction with radiation therapy. Studies have suggested a synergistic effect whereby chemotherapy enhances the effect of radiation on cancer cells without unduly sensitizing normal cells. Chemotherapy has the additional advantage in that it may be able to eliminate small cancerous deposits located outside the radiation field.

Side-effects

Side effects of radiation therapy for Esophageal Cancer include esophageal irritation and fatigue. The esophageal irritation is a moderately severe difficulty which typically develops two to three weeks after the radiation initially begins. There are medications that help control the sore throat, but it is not possible to prevent the it entirely. Medications include soothing medicines such as Carafate and numbing medicines such as Ron’s Rum. Another important class of medications that is helpful in these situations is antifungal treatment. Patients receiving radiation therapy and chemotherapy for Esophageal Cancer are prone to develop a yeast infection (monilia). Medicines such as Diflucan or Nystatin can be quite beneficial.

Of course, patients with Esophageal Cancer are also at risk for inadequate nutrition. Nutritional support can include counseling, as certain foods are much easier to swallow. Nutritional support can also be administered mechanically by the placement of a rubber tube directly through the skin of the abdomen into the stomach (a PEG tube). Please refer to the separate section in nutrition for more details regarding nutritional support.

A final side effect of radiation therapy is fatigue. Patients receiving radiation often complain that they just don't have quite the energy that they did before the radiation started. Some of this may be due to the underlying cancer itself. The radiation, however, does tend to make people feel tired. There is no cure for this symptom, but a program of extra naps and mild exercise can be helpful.