Radiation Therapy for Esophageal Cancer

This content has been reviewed and approved by

Chandra P. Belani, MD
Deputy Director, Penn State Cancer Institute
Miriam Beckner Professor of Medicine
Penn State University School of Medicine

Radiation therapy can be an integral part of treating your esophageal cancer. However, because physicians do not treat esophageal cancer with radiation therapy exclusively, it is important for you to receive treatment in an environment that involves 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 your cancer to relapse locally (to a nearby site). Radiation therapy uses high energy x-rays to kill cancer cells that remain in or near the esophagus and surrounding lymph nodes.

Delivering radiation therapy to the esophagus and surrounding lymph nodes can occur either externally or internally.

• 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 to 6 weeks, depending on the overall goals of treatment and each treatment lasts between 10 to 15 minutes.
• Brachytherapy - delivers radiation therapy internally and involves placing a radioactive isotope, such as iridium 192, within the esophagus.

Primary Treatment With Radiation Therapy

Physicians do not recommend external beam radiation therapy alone for primary treatment of esophageal cancer because radiation administered in combination with chemotherapy improves survival compared with treatment with radiation alone.

In general, current evidence suggests that combined chemotherapy and radiation therapy is superior to either therapy alone as primary therapy for esophageal cancer.

However, your physician may suggest using radiation therapy alone to treat localized cancer if you cannot tolerate surgery or chemotherapy. Treatment with radiation therapy alone results in an approximate18 percent survival rate at 1 year, an 8 percent survival rate at 2 years, and less than 5 percent survival at 5 years in patients with localized esophageal cancer (stage I through III).

Your physician may use radiation therapy alone to decrease your symptoms if you have more advanced disease, are medically unable to receive surgery or chemotherapy, or if your cancer recurs after surgery. However, patients with locally recurrent cancer usually receive radiation plus chemotherapy.

Side Effects of Radiation Therapy

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

Research is in progress to refine existing treatments and develop new ones. For information on some of the techniques currently under investigation, see Strategies to Improve Treatment.