Esophageal Cancer: Radiation Therapy

Radiation therapy for esophageal cancer is the use of high-energy beams to shrink or eliminate tumors.

Memorial Sloan Kettering has been a leader in efforts to improve radiation therapy for esophageal cancer. We have developed and refined the use of sophisticated tools – including state-of-the-art linear accelerators, advanced imaging approaches, and high-speed computer-based systems – to deliver powerful doses of radiation to tumors with remarkable precision. Our radiation team works together to offer the highest level of safety during every step of your treatment.

When Radiation Therapy Is Used

While it is not common to treat esophageal cancer with radiation therapy alone, this type of treatment plays an important role in combination with chemotherapy and surgery. Often, patients begin treatment for esophageal cancer by receiving four to six weeks of radiation therapy in combination with chemotherapy. This combination treatment is sometimes called chemoradiation.

In some cases, particularly in patients with squamous cell carcinoma, chemoradiation is the primary therapy and surgery is used only if the tumor does not have a complete response to the chemoradiation. In other cases, chemoradiation is performed to shrink the tumor before surgery.

In addition, radiation therapy can be used as a palliative treatment. In this situation, the therapy is not intended to cure the cancer, but to relieve pain and discomfort that cancer can cause. For example, radiation therapy can shrink a tumor to improve swallowing or eliminate metastases in other parts of the body.

Types of Radiation Therapy

Memorial Sloan Kettering’s radiation oncology team uses state-of-the-art technologies for radiation therapy, including intensity-modulated radiation therapy and image-guided radiation therapy.

Intensity-Modulated Radiation Therapy

Intensity-modulated radiation therapy (IMRT) is a type of external-beam radiation therapy that targets tumors more accurately than conventional radiation therapy. Using computer software and three-dimensional images from CT scans, the radiation oncologist is able to focus several small radiation beams of varying intensity on and around the tumor. This results in highly targeted treatment, with high doses trained directly on cancerous areas, sparing  surrounding organs.(1)

Image-Guided Radiation Therapy

Image-guided radiation therapy (IGRT) uses real-time imaging to mold radiation beams to the contours of your tumor. In IGRT, imaging methods such as CT, ultrasound, or other guidance systems are performed during each radiation treatment in order to deliver more-precise doses. This technique addresses the problem of the esophagus moving slightly during or between treatments as a result of physical activity, respiration, and other bodily functions.

Radiation Safety

Ensuring your safety during radiation therapy is of the utmost importance at Memorial Sloan Kettering.

When treating esophageal cancer with IMRT or IGRT, we use an approach called respiratory gating to enhance the accuracy of your treatment. Because the esophagus moves as you breathe, in respiratory gating computers analyze your breathing cycle and release radiation only at certain points in the cycle. This is particularly helpful when radiating tumors at the gastroesophageal junction, where there is a lot of motion.

Our medical physicists work closely with your radiation oncologist to plan radiation dosage before your treatment begins. We have also implemented extensive safety protocols to manage our radiation therapy program. Redundancy is built into the review of the computer-based calculations that control radiation dosage, so that multiple experts check them independently. Medical physicists also examine machinery frequently to maintain proper functioning.

In addition, our doctors participate in research efforts aimed at reducing radiation toxicity, particularly to the heart and lungs.