Thoracic Oncology Program

Esophageal Cancer

Chemotherapy & Radiation Therapy

Multimodality therapy has been recommended as the most effective means of treating your cancer. This a combined approach, utilizing chemotherapy and radiation therapy that may or may not be followed by surgery.

Chemotherapy and radiation therapy are used together in esophageal cancer to shrink the tumor and decrease the chance of any cancer cells surviving elsewhere in the body.

Radiation Therapy

Radiation therapy will help shrink your tumor. This therapy uses a form of high energy x-rays which are carefully directed at your tumor and the surrounding tissue which is at high risk for local spread. The high energy beams can kill cells and keep them from dividing and spreading. This helps destroy the tumor, because cancer cells divide and grow faster than normal cells. Normal cells usually recover successfully from radiation, but the high energy beams will be carefully aimed to target your tumor and lymph nodes and minimize the amount of normal tissue affected.

Your initial appointment in the Radiation Oncology Department will be used to create a treatment field, this is known as simulation. A custom set of "blocks" will be designed that allow us to treat your cancer while protecting your healthy tissue & organs. These blocks will be placed between you and the radiation machine during each treatment session. You will not feel the radiation while it is being delivered, and the actual treatment will take less than 5 minutes. Expect to be in the department for 15 to 30 minutes each day ( some patients are treated twice a day during the 2 weeks of chemotherapy), so that the machine can be properly set up for your individual needs.

Schedule

Simulation - a 1 hour appointment ( a second appointment for check films may be needed)
Radiation therapy - once or twice daily for approximately 30 minutes for a total of 5 ½ weeks. The first and fifth weeks of therapy will be given while you are in the hospital receiving chemotherapy.
A CT scan will be performed in the third week of therapy. This scan is for treatment planning purposes only and will not be used to evaluate tumor shrinkage.

Common Side Effects

Esophagitis - between the third and fourth weeks of treatment many patients develop pain or discomfort when swallowing. This can make it difficult to eat and drink normally. Medicine to help numb your esophagus prior to eating can be prescribed for you. Other pain medicine is also available as a liquid or a patch.
Fatigue - you may feel very tired, particularly during the last several weeks of therapy. Your body is working hard to fight the cancer, give it what it needs - REST!
Hair loss - you will lose the hair on your chest that is within the treatment field. This hair will most likely grow back later, after the radiation treatments have stopped.
Skin Changes - your skin may become very dry, irritated and red within your treatment field. Treat this area gently. Avoid using powders, lotions or creams not prescribed by your doctor on this area.
Decreased appetite - this may be related to fatigue, change in taste from the chemotherapy or from pain and irritation caused by radiation. In addition to eating whatever foods appeal to you, try to drink 3-4 cans of supplements ( such as Boost, Ensure, Scandishake, etc.) each day. Make milkshakes with the supplements, add your favorite candy, peanut butter, whatever - be creative & add lots of calories! If you notice tenderness or sores in your mouth or lips please let us know.

Chemotherapy

You will receive your chemotherapy as an inpatient in the Greenebaum Cancer Center. You will continue to receive radiation therapy once or twice each day during these admissions.

The chemotherapy medications are specifically designed to work together with the radiation therapy and enhance the effects of the radiation. You will receive 2 chemotherapy medications given by IV - Cisplatin on the first day and 5-FU (Fluorouracil) by continuous infusion for 4 days. You will receive chemotherapy twice during your treatment (wee 1 and week 5). The exact doses will be calculated using your weight, height and lab values.

You will receive other medications before and during your chemotherapy to minimize and relieve the side effects. You will also be given extra fluid and electrolytes through your IV during the treatment. Everyone reacts to the chemotherapy differently. Medicine to relieve many of the symptoms is available and can be prescribed for you. Adjustments to your chemotherapy dose may be necessary if the side effects are severe. It is very important that you communicate with us about how you are feeling.

Common side effects

Common side effects of these chemotherapy drugs are nausea, vomiting, diarrhea, hiccoughs and decreased electrolyte and blood cell counts. Cisplatin can also cause changes in hearing and kidney function. Patients often report a metallic taste during the chemotherapy. 5FU can cause soreness in the mouth that may make eating uncomfortable.

Bone marrow suppression (also referred to as low blood cell counts) can occur with chemotherapy or radiation therapy. While you are in the hospital you will have blood drawn every morning to make sure your blood cell counts are not too low. You will also have your blood drawn at least once in between treatments. There are several types of blood cells that may be affected:
White blood cells - these cells help fight infection. Cancer therapy can deplete your body of these cells. The normal level is at least 4,000, but while you are receiving chemotherapy, we expect it to be lower. If the count is too low (below 1,000 - 1,200), we will likely postpone therapy for a week until your white blood cell count rises. In some cases, a daily injection called GCSF or Neupogen is given for 5-7 days after chemotherapy to help your body make more white blood cells.
Platelets - these cells help form clots and prevent bleeding. Cancer therapy can also deplete the number of these cells. The normal platelet count is at least 130,000, but while your are receiving therapy, it may be lower. If your platelet count is less than 100,000, we will likely postpone chemotherapy for a week. If your platelet level is too low and you are having abnormal bleeding (such as nosebleeds or bleeding gums), we may recommend a platelet transfusion.
Hematocrit - this number refers to the amount of red blood cells you have circulating in your blood and how much room is available for carrying oxygen. When this level is low, you may feel very tired and have little or no energy. If it is too low, we may prescribe iron tablets or a weekly injection called Epogen or Procrit. If the level is very low (below 25) and you are having symptoms such as dizziness or weakness, we will likely recommend a blood transfusion.

This page was last updated on: March 3, 2008.