Effective Radiation Therapy for Esophageal Cancer: Benefits, Side Effects, and Treatment Insights

Radiation therapy is a vital component in the treatment of esophageal cancer at every stage. It is frequently combined with chemotherapy and sometimes surgery to improve outcomes and aim for a cure.

This treatment uses targeted radiation to eliminate cancer cells and is often part of a multidisciplinary approach alongside chemotherapy or surgical procedures.

Esophageal cancer remains a significant health challenge, causing over 16,000 deaths annually in the United States.

For early-stage esophageal cancer, the standard approach involves chemotherapy and radiation therapy before surgery. When the cancer has spread beyond the esophagus, chemotherapy combined with radiation often serves as the primary treatment.

Keep reading to understand how radiation therapy works in managing esophageal cancer and what patients should know.

Radiation Therapy Types for Esophageal Cancer

Two main types of radiation therapy are utilized in treating esophageal cancer.

External Beam Radiation Therapy

This is the predominant radiation treatment where radiation beams are directed externally at the tumor to destroy cancer cells.

Emerging treatments such as proton therapy are under study, showing promise in reducing side effects compared to traditional radiation methods.

Internal Radiation Therapy (Brachytherapy)

Brachytherapy involves placing radioactive material inside the esophagus near the tumor via a tube. While less common, it can help alleviate swallowing difficulties.

There are two brachytherapy approaches:

• High-dose brachytherapy: Radioactive material is positioned near the tumor for a few minutes.
• Low-dose brachytherapy: A lower radioactivity source remains near the tumor for 1–2 days, requiring hospital stay.

Advantages of Radiation Therapy in Esophageal Cancer Treatment

When combined with chemotherapy or surgery, radiation therapy enhances the chances of curing esophageal cancer.

It is used to:

• Treat patients who cannot undergo surgery by combining with chemotherapy
• Shrink tumors before surgery
• Destroy residual cancer cells post-surgery
• Relieve symptoms in advanced cancer cases

Possible Side Effects of Radiation Therapy

Radiation therapy can affect healthy tissues, leading to side effects that should be discussed with your healthcare team.

Common side effects include:

• Fatigue
• Headaches
• Skin irritation
• Loss of appetite
• Nausea and vomiting
• Diarrhea
• Mouth sores and dryness
• Thickened saliva
• Heart complications
• Radiation esophagitis causing painful swallowing, eating difficulties, and chest discomfort
• Radiation pneumonia with symptoms like fever, cough, chest pain, and shortness of breath

Side effects may intensify when radiation is combined with chemotherapy.

Success Rates and Prognosis

Early detection of esophageal cancer significantly improves the likelihood of cure. Radiation therapy plays a key role in enhancing survival chances.

A 2019 study demonstrated that radiation therapy effectively controlled small cell carcinoma of the esophagus, with half of the patients surviving at least 36.8 months when cancer was localized.

What to Expect During Radiation Treatment

Pre-Treatment

Before beginning therapy, imaging tests like CT scans help doctors precisely target radiation. Small permanent marks or tattoos may be placed to guide treatment.

During Treatment

External beam radiation sessions resemble X-rays but last longer. Patients lie still while radiation is delivered, and the process is painless.

Post-Treatment

Patients usually return home immediately after external radiation. Hospital stays may be needed for certain internal radiation therapies.

Who Should Consider or Avoid Radiation Therapy?

Most patients in suitable health are candidates for radiation therapy. However, those with poor overall health, compromised heart or lung function, severe esophageal bleeding, or esophageal fistulas, as well as pregnant women, may not be eligible.

Alternative and Complementary Treatments

Other treatment options include surgery, chemotherapy, combined chemo-radiation, laser therapy, electrocoagulation, and immunotherapy.

Common Questions About Radiation Therapy for Esophageal Cancer

What is the long-term survival rate after radiation therapy for esophageal cancer?

The 5-year relative survival rate for esophageal cancer confined to the esophagus is approximately 47%, while it drops to 6% when cancer spreads to distant organs.

How many radiation treatments are typically required?

Standard treatment involves about 28 sessions delivering a total dose of 50.4 gray (Gy) combined with chemotherapy, usually administered five days a week.

How long does each radiation session last?

Each external radiation session typically takes 15 to 30 minutes, with the actual radiation delivery lasting only a few minutes.

Conclusion

Radiation therapy remains a cornerstone in managing esophageal cancer across all stages. It is often combined with chemotherapy and surgery to maximize treatment success.

For patients unable to undergo surgery, radiation combined with chemotherapy offers a valuable treatment option, also helping to alleviate symptoms in advanced disease.

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