Radiation therapy for esophageal cancer:
- Neoadjuvant (preoperative) radiochemotherapy (RCTX: combination of radiotherapy (radiotherapy, radiatio) and chemotherapy) to reduce tumor size.
- In case of a locoregional R2 resection (larger, macroscopically visible parts of the tumor could not be resected), postoperative radiochemotherapy (RCTX) can be performed after discussion in the interdisciplinary tumor conference (advantage is not clearly proven; is associated with stronger side effects than preoperative radiochemotherapy)
- Palliative brachytherapy (short-distance radiotherapy in which the distance between the radiation source and the clinical target volume is less than 10 cm) should be offered as part of the multidisciplinary care of patients with esophageal cancer to alleviate dysphagia, if necessary in combination with stent implantation (medical implant to keep the esophagus open) or percutaneous radiochemotherapy.
- Proximal/cervical esophageal carcinomas (extend approximately 6-8 cm to the upper thoracic aperture/upper opening of the chest; approximately 5% of cases):
- Combined radiochemotherapy as treatment of choice; it often allows preservation of larynx (larynx) and hypopharynx (lower pharyngeal region)
- Radiotherapy (in this case: Intensity-modulated radiotherapy): initially good local results, but in 50-70% of patients shows in the course of the disease a local recurrence (recurrence of the disease at the same site) and in about 40% a distant metastasis (settlement of tumor cells from the site of origin via the blood / lymphatic system to a distant site in the body and there grow new tumor tissue).
Other notes
- Neoadjuvant radiochemotherapy (RCTX; therapy to achieve an improved baseline for surgery) significantly prolonged survival in patients with resectable esophageal cancer.
Guideline
- S3 guideline: diagnosis and therapy of squamous cell carcinoma and adenocarcinoma of the esophagus. (AWMF register number: 021-023OL), December 2018 Abstract Long version.
