Esophagus - radiation therapy in the treatment of cancer. Surgical and drug treatment of esophageal cancer Preparation and conduct of radiation therapy

Organs digestive system– one of the main places of localization of pathological malignant neoplasms.

Moreover, esophageal cancer is the most common diagnosis, accounting for about 90% of all identified gastrointestinal tract tumors.

The disease is characterized by relatively slow progression. What kind of anomaly is this, and most importantly, what are the methods to eliminate it?

Esophageal cancer is an atypical mutation of the cells of the esophagus, causing the appearance of cancerous tumors in its tissues. Basically, it has a squamous cell structure. If treatment is not carried out in a timely manner, it is characterized by extreme aggressiveness and an unfavorable life prognosis.

In most cases, from the moment the disease is diagnosed to death, in case of late detection, it takes about six months. If a pathology is detected at the stage of its formation, the patient has every chance of overcoming the 5-6 year survival threshold.

It is noteworthy that men suffer from esophageal cancer three times more often than women. The peak of defeat occurs in the older age age group- from 70 years old.

What can medicine do?

Treatment of the pathology is determined by the stage and degree of organ damage, as well as the general physical condition of the patient as a whole, and mainly includes surgical interventions, chemotherapy and radiation exposure.

Positive dynamics are achieved in isolated cases - the exception is patients with limited lesions. Several areas of treatment are identified:

basic– involves radical or gentle (depending on the medical history) surgical intervention. Despite a large number of techniques are considered the main and most effective option for combating esophageal cancer.

After the operation, a course of exposure to radiation flows or administration of cytostatic drugs is carried out. The principle of the main direction of treatment is maximum suppression of the activity of cancer cells and elimination of the lesion.

The goal is a complete or partial cure of the patient and bringing his living conditions closer to moderately comfortable;

palliative– applicable to patients with contraindications to surgery or in case of inoperability of this form of cancer. It can give a pronounced effect with a comprehensive selection of conservative methods of suppressing the activity of cancer cells, bypassing the attempt to amputate the site of primary localization of the tumor.

With a well-chosen treatment regimen, long-term clinical improvements are possible, increasing the quality of life and prolonging its duration;

supportive- To this method effects on the tumor include conservative methods treatment. Prescribed at stages of active progression, when surgery will no longer bring positive result and the growth of the anomaly is practically uncontrollable.

A course of chemotherapy drugs will slow down the spread of the tumor to neighboring tissues, reduce the rate of metastasis, and radiation will stop the development of secondary cancer and slow down the atypical processes of cellular malignancy.

In addition, the main goal of maintenance treatment is to reduce the symptomatic manifestations of the disease, which in the final stages are quite pronounced and difficult to tolerate by the patient.

Taking painkillers will help a person cope with pain syndrome, and drugs with a targeted spectrum of action will somewhat prolong his life.

Surgical intervention

For an effective result during surgical intervention, a radical resection with a general block is required, including amputation of the tumor itself at the level of tissues that have retained their structural integrity and have not undergone cellular mutation.

As well as all lymph node connections that could potentially be affected by cancerous formations. In addition, removal of the proximal part of the stomach, which contains the distal pathway for the outflow of lymphatic fluid, is indicated.

The technique involves additional mobilization of the gastric region in the upper direction, followed by the formation of an anastomosis, and general mobilization of the large and small intestines.

A mandatory step when performing esophageal resection is lymph node dissection.– at least in two cavities of lymphatic metastasis. These are mainly the submandibular lymph nodes.

Pyroplasty, used during the manipulation process, will make it possible to drain the stomach. These procedures are extremely complex, and the age factor does not play in the patient’s favor. Hence the risk of complications and the development of internal inflammation of soft tissues.

TO postoperative complications include the development of fistulas, insufficient functionality of the anastomosis, the bile reflex, provoking severe pain behind the chest area, circulatory disorders, heart failure. Death occurs in 10% of cases.

Chemotherapy

Tumors affecting the esophagus are characterized by a low degree of sensitivity to the damaging effects of the chemical components contained in anticancer drugs.

For this reason, the treatment method is used only in a comprehensive manner, and its effectiveness in reducing the size of the tumor is about 10–30%. It is worth noting that the degree of positive dynamics does not depend on the name of the chosen drug - their damaging ability to affect the anomaly is almost identical.

For this type of cancer, combined dosage regimens are prescribed medicines. Basically, these are Cisplatin and 5-fluorouracil, as well as their derivatives - Doxorubicin, Bleomycin, Mitomycin, Vindesine. They are more adapted than others to eliminate active squamous cell formations.

The treatment system is based on a complex combination with radiation therapy, which precedes a course of chemotherapy.

Depending on the clinical picture progression of the disease, the patient is prescribed 4 to 6 courses, each of which has a 21-day break, after which the selected regimen for taking cytostatics is repeated. When used comprehensively, the effectiveness of the method is up to 40%.

The main complication after such treatment is excessive toxicity of the body caused by tumor decay products, as well as the negative effect of the drugs themselves on the human body. Most often, the patient is plagued by: nausea, vomiting, weakness, blood pathologies, liver dysfunction.

Radiation therapy

Radiation treatment of an esophageal tumor, when surgery is contraindicated, is still considered the most effective treatment option for patients with this diagnosis and is characterized as palliative.

Modern techniques and innovative equipment help increase the effectiveness of radiation beams by delivering them precisely to the site of the tumor, which has reduced the symptomatic manifestations of the disease by an average of 35%.

The intracavitary irradiation method gives particularly stable positive dynamics.. The essence of the technology is the introduction of a special thin probing device into the lumen of the department so that the cobalt tip, emitting radioactive wave vibrations, is fixed at the level of the tumor formation site.

Irradiation devices are placed along the perimeter of the pathology borders and affect it as accurately as possible.

The effectiveness of such procedures can prolong the patient’s life by an average of 10 – 12 months, subject to overall satisfactory physical condition body.

Features of therapy at each stage

The specifics of therapy, its goals and objectives, as well as the combination of methods and duration of courses for this form of cancer primarily depend on the stage of the disease and are as follows:

Stage 1– is a stage of formation and how well the treatment is chosen depends on the patient’s chance of full recovery. Basically, this is a surgical intervention - its effectiveness at this stage is highest. To consolidate positive dynamics and reduce the risk of developing recurrent processes, a course is indicated radiation therapy;

Stage 2– depending on the extent of the spread of the tumor, the doctor can either perform surgery – if the lesion is in the upper or lower third of the esophagus, or limit himself to radiation – if the pathology has formed in the central zone of the esophagus. Gentle resection is acceptable.

Additionally, X-ray therapy is performed - rotational damage through radiation or intracavitary radiation therapy;

Stage 3- on at this stage Surgery, as a rule, is no longer prescribed due to its low effectiveness. Telegammatherapy and x-ray irradiation– the most justified methods for supporting complex effects on the tumor.

If, as a result of these measures, the magnitude of the pathology has decreased by 35–40%, after a course of radiation therapy, amputation of the tumor can be considered in the manner described above.

At the rehabilitation stage - courses of chemotherapy to minimize the risk of developing secondary cancer, which occurs in more than 50% of cases;

Stage 4– surgery and radiation are excluded. Carried out only symptomatic treatment, aimed at improving the patient’s quality of life and maximizing its prolongation. As additional measures, fistula, anastomosis and other options for palliative effects on the organ are applicable.

More details about the selection of treatment methods are described in the video from the medical conference:

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It is generally accepted that surgery is best suited for the treatment of adenocarcinoma of the esophagus (almost always lesions of the lower third), if the lesions are operable. In most other cases, especially for lesions in upper third and cervical esophagus, best choice Treatment is a combination of chemotherapy and radiation therapy. The surgeon or radiotherapist must determine the type of treatment (radical or palliative) before starting local therapy.

Radical treatment of esophageal cancer

When thinking through radical surgery For patients who are generally eligible and have no evidence of distant metastasis, it is important to determine the extent of the lesion before definitive resection. For this purpose, exploratory laparotomy is recommended, which has become a routine part of many operations, where recovery is achieved by moving (transposing) the colon and thereby creating a viable channel between the pharynx and the stomach.

Radical removal of the esophagus, first performed by Czerny more than 100 years ago, is now carried out in one stage with gastroesophageal anastomosis or relocation (transposition) of the colon. Previously, during operations, a permanent gastrostomy tube was left in place to provide nutrition.

Only a smaller part patients with esophageal cancer can be radically operated, the most common indication for such an operation is lesions of the middle or lower third of the esophagus, especially if, according to histology, this lesion is adenocarcinoma, and patients without obvious signs presence of metastases. Until recently, there was little indication that preoperative radiotherapy or chemotherapy had an effect on the extent of resection, operative mortality rates, or overall survival.

But in a recent large-scale study in Great Britain showed striking improvement with the use of a preoperative combination of chemotherapy (cisplatin and fluorouracil) with radiation therapy. Survival rates at 2 years were 43% and 34% (with and without chemotherapy); median survival rates (with chemotherapy) were 16.8 months compared with 13.3 months (without chemotherapy). Data from previous studies have been disappointing.

Surgery for esophageal cancer:
(A) complete removal esophagus with replacement by the colon;
(b) gastric mobilization and reduction in the case of carcinoma of the lower third of the esophagus.

For the sick carcinoma In the upper third of the esophagus, radiation therapy is usually chosen as treatment, but some doctors are inclined to surgical treatment in this case. There have been no randomized comparisons of these types of treatments. Combinations of chemoradiotherapy are now considered much more effective than radiation therapy alone.

Radiation therapy(with or without concomitant chemotherapy) has several advantages over surgery, including wider applicability (most patients are elderly and poorly nourished), the ability to avoid laryngectomy, and significant relief of dysphagia for most patients, with cure at least 10% of patients are able to tolerate high doses: a total of 60 Gy in daily portions for 6 weeks. In addition, surgery has a mortality rate of approximately 10% (Fig. 14.6) and, unlike radiation therapy, is not suitable for patients with regional spread of the disease.

Indeed, the classic review states mortality rate, equal to 29% for patients worldwide treated in the 1970s, although mortality during operations has decreased with improved patient selection, surgical technique and supportive treatment. Despite the bad general results, the advantage of surgery is that the temporary relief can be very good and, like radiation therapy, it can lead to a cure in some cases.

Upper third esophagus technically difficult to irradiate due to the length of the treatment area and proximity spinal cord. Irradiation zones should ideally extend at least 5 cm above and below the known limits of disease spread to adequately treat possible extension of the lesion into the submucosal wall. As with post-signet carcinomas, complex techniques, using intertwined, wedged, inclined, multiple irradiation fields, often with compensators (transformers).

It is also necessary to carefully planning irradiation at two or three levels so that the cylindrical tissue receives the same high dose of radiation, but does not overexpose the adjacent spinal cord.

Radical radiotherapy for carcinoma cervical spine esophagus.
Due to asymmetrical anatomy, a complex multifield radiation plan is required.

At tumors middle third esophagus Radiation therapy is increasingly used as the primary treatment, sometimes in combination with surgery. Some surgeons believe that surgery is easier and long-term results are better with preoperative radiation. In technical terms, preoperative and radical radiation therapy for tumors of the middle third of the esophagus is easier to carry out than for tumors of the upper third of the esophagus. As with tumors of the upper third of the esophagus, synchronous chemotherapy and radiation therapy are now widely used for the middle third of the esophagus; In our center, the standard of treatment is now a combination of mitomycin C and 5-FU.

When cancer of the lower third of the esophagus Surgery is often preferred, with reconstruction, usually performed with the scapula mobilized, being less complex.

At cancer of the lower third of the esophagus there is a risk that the stomach will be affected by tumor and will not be suitable for reconstruction. For inoperable tumors, radiation therapy may be helpful.

Complications in the treatment of tumors of all departments can be difficult or even severe both in the case of radiation therapy and surgery. Radical radiation therapy is often accompanied by radiation inflammation of the esophagus (esophagitis), requiring treatment with alkaline or aspirin-containing suspensions for local action on the inflamed esophageal mucosa.

Possible later complications include radiation damage to the spinal cord and lungs, leading to radiation pulmonitis and sometimes shortness of breath, coughing and decreased respiratory capacity, but such events are rare in everyday practice. Fibrosis and scarring of the esophagus leads to stricture, which may require dilatation to keep the esophagus open. Despite the above facts, most patients tolerate this treatment surprisingly well, even with chemotherapy.

TO surgical complications include esophageal stricture and anastomotic failure, resulting in mediastinitis, pneumonitis and sepsis, sometimes leading to the death of the patient.

In patients with dysplasia high grade in Barrett's esophagus The use of photodynamic therapy has shown promise. The data is still collected on a small number of patients, but this treatment has already been recognized by the National Institute of Clinical Excellence (NICE) as suitable in some cases.

Palliative treatment of esophageal cancer

Palliative treatment for esophageal cancer can be very beneficial with the use of a Celestine or other permanent prosthesis, radiation therapy or laser treatment(as well as both), or sometimes in a bypass operation, without attempting to remove the site of the primary tumor, but creating an alternative channel. For patients who cannot undergo radical surgery and radiotherapy, palliative treatment should always be considered, especially in cases of severe dysphagia. Moderate doses of radiation can lead to significant clinical improvements.

IN in experienced hands holding the Celestian or expandable esophageal tube with metal mesh is relatively safe and effective procedure, which can be combined with radiation therapy. Common problems with tube insertion include tube migration, gastroesophageal fistula (sometimes associated with gastric contents leaking into the lungs), chest pain and discomfort. Complications from palliative radiation are minimal because low doses are used: treatment with 30 Gy over a 2-week period is usually beneficial unless the dysphagia is total and high doses are rarely needed. Intraesophageal brachytherapy is widely used at our center and offers a simple and rapid alternative.

Malignant tumor of the esophagus (esophageal cancer) is the 6th most common malignant tumor. The main treatments for esophageal cancer include surgery and radiation therapy.

Radiation therapy can be used as an independent treatment for esophageal cancer (if initial stages diseases without signs and when radical surgery impossible for any reason), but can be used in combination with surgery and/or chemotherapy. Irradiation can be carried out either remotely or by contact. In the second case, the radiation source is placed in the lumen of the esophagus near the tumor.

The use of radiation therapy for the treatment of esophageal cancer affects both the tumor itself (reduction in size, decreased growth activity, better operability) and on the path of lymph outflow from the esophagus, killing tumor cells that may be in regional lymph nodes.

For operable esophageal cancer, radiation therapy is carried out in courses, before and after surgery. Before surgical intervention Radiotherapy is used for infiltrative and undifferentiated forms of cancer, as well as for tumors located in the middle and upper part of the esophagus - in places where radical tumor removal is quite difficult. After surgery, radiotherapy is carried out when surgery fails to completely remove the tumor, or if there is a risk of cancer cells entering the surrounding tissue.

For inoperable forms of esophageal cancer, radiotherapy is usually used as part of complex schemes treatment, together with chemotherapy treatment. For example, the use of a combination of cisplatin and 5-fluorouracil together with radiotherapy (with a dose of 50 Gy) leads to complete regression of the tumor process in approximately 20% of patients.

In advanced forms of cancer, in the presence of distant metastases, surgical treatment is useless due to the prevalence of the tumor process. For this group of patients, the main task is to maintain or restore enteral nutrition (which is impaired due to tumor development). Among the palliative methods that are used in these cases are endoscopic laser or electrocoagulation, transtumoral intubation of the esophagus through the narrowing site, and radiation therapy (intracavitary).

Intracavitary irradiation is carried out by placing radioactive sources into the lumen of a probe, which is installed in the lumen of the esophagus in the area where the tumor is located. With esophageal stenosis, the patient's condition can improve through the use of parenteral nutrition and/or gastrostomy, which precede the implementation of a palliative radiotherapy program.

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At the Assuta Clinic, when treating esophageal cancer in Israel, a team of highly professional doctors interacts with the patient, including oncologists, surgeons, radiation therapists, rehabilitation specialists, nutritionists, etc. Innovative methods are used such as:

Minimally invasive surgery.
Endoscopic surgery.
Radiotherapy.
Targeted therapy.

In addition, participation in clinical trials is offered.

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Surgery

This is basic in Israel when the disease is not affected The lymph nodes. The most common procedure is esophagectomy; there are several approaches to performing it. The doctor will recommend the most appropriate technique based on the location of the tumor and the presence/absence of secondary lesions.

Typically, the operation involves removing:

parts or all of the esophagus;
stomach segment;
lymph nodes located close to the malignant focus.

The remaining part of the stomach is pulled up and connected to a segment of the esophagus. A feeding tube may be necessary until the patient is able to feed himself.

Potential side effects surgeries include:

anastomotic leak;
difficulty swallowing;
heartburn;
Digestive problems.

Chemotherapy for the treatment of esophageal cancer in Israel

Chemotherapy uses cytotoxic drugs to fight cancer by stopping its growth. Chemotherapy drugs travel through the bloodstream and reach malignant cells throughout the body.

To introduce them into the body, injections, droppers (for intravenous infusion), and pumps are used.

List of possible questions that you can ask a doctor at the Assuta clinic:

Why in in this case Do you need treatment with cytotoxic drugs?
What is the purpose of chemotherapy in a particular case?
Are there alternatives?
How is the treatment performed?
Will a central catheter be required?
What are the long-term and short-term side effects?
What measures can be taken to alleviate the unwanted effects of therapy?
What is the duration of the course?
Will chemotherapy be given on an outpatient basis or will hospitalization be required?

Chemotherapy for esophageal cancer before surgery

Most patients undergoing surgical treatment for esophageal cancer are prescribed cytostatic therapy. results clinical trials show that such treatment reduces the risk of relapse at stages 2 and 3 of the disease. This type of treatment also reduces the size of the malignant tumor so that it is easier for the surgeon to remove it. A drug regimen often used is cisplatin and fluorouracil (5-fu).

Chemotherapy for esophageal cancer before and after surgery

If the diagnosis is of the lower esophagus or the tumor is located in the esophagogastric junction, chemotherapy may be required before and after surgery (perioperative). It reduces the size of the tumor and the chances of the disease returning.

Combination of chemotherapy and radiotherapy

This type of treatment is otherwise called chemoradiotherapy. It is sometimes prescribed before surgery to reduce the risk of recurrence.

If the tumor has not spread but is difficult to remove, chemoradiotherapy can shrink the tumor. The surgeon can then remove it. This type of treatment for esophageal cancer is effective before surgery for adenocarcinoma and squamous cell cancer.

When surgery cannot be performed or the patient does not consent, doctors may recommend chemoradiotherapy as an independent method, especially for squamous cell carcinoma in the upper third of the esophagus. In this situation, many experts believe that the results of this treatment are as effective as surgery.

Chemoradiation therapy is enough intensive treatment. It is difficult to complete the entire course, and the side effects will be more severe than they would be taken individually. When making a decision, the doctor will assess the health status and whether the patient can tolerate it.

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Chemotherapy for esophageal cancer to control symptoms

When metastases occur in the body, chemotherapy is recommended to reduce tumor formation, slow the growth of the disease, and reduce its manifestations, for example, difficulties in swallowing. Treatment consists mainly of combinations of cytostatic agents. They will enter the body through IVs and tablets. The main goal is to alleviate the patient’s condition so that the undesirable consequences of therapy do not outweigh the benefits.

In case of adenocarcinoma of the esophagogastric junction or the presence of a large amount of HER2 protein on the surface of cancer cells, targeted therapy - Herceptin with cytostatics - may be recommended.

If chemotherapy is not effective, laser treatment for esophageal cancer or the placement of a stent may be suggested to allow food to pass down the esophagus.

Before chemotherapy, you should consult with your doctor about the dietary supplements you are taking. medicinal herbs, herbal preparations. They can reduce the effectiveness of cytostatics.

Chemotherapy drugs for esophageal cancer

Doctors use several different medications and their combinations to treat this disease. Results are better when multiple drugs are used.

The choice is determined by the type of esophageal cancer and the stage of the disease. Based on research, it was found that certain cytostatics are more effective in the treatment of adenocarcinoma, while others are more effective in the treatment of squamous cell carcinoma. If chemotherapy is considered in advanced stages of esophageal cancer, it is tailored to minimize side effects.

Chemotherapy drugs:

Epirubicin.
Fluorouracil, also called 5-FU.
Capecitabine, another name is Xeloda.
Cisplatin, and sometimes carboplatin is used.
Oxaliplatin.
Paclitaxel (Taxol).

Usually a combination of 2 or 3 drugs is prescribed - a combination, for example, ECF includes epirubicin, cisplatin and fluorouracil.

Some of the most common combinations for esophageal adenocarcinoma are:

CF or CX - cisplatin and fluorouracil or capecitabine and cisplatin.
ECF - epirubicin, cisplatin and fluorouracil.
EOX - epirubicin, oxaliplatin and capecitabine.

Israeli doctors also use irinotecan and vinorelbine.

Droppers are used to administer most medications. To take fluorouracil, you will need a central catheter and continuous flow of the drug into the body for several days or weeks. The pump is installed in the clinic.

Capecitabine is a fluorouracil tablet. Taking pills is often easier for patients. The drug is prescribed twice a day during the entire course of treatment for esophageal cancer in Israel.

Most combinations of cytostatics are given on an outpatient basis, sometimes requiring an overnight stay.

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Side effects of chemotherapy for esophageal cancer

Treatment with cytostatics causes certain side effects, which are caused by a number of factors:

prescribed medications;
dosage of medication;
individual reaction of the body.

Not every patient experiences all possible side effects. Some people react more than others. And different drugs have different unwanted effects. Therefore there is no way to accurately predict. Majority side effects lasts several days while the medication is continued. List of some common adverse events:

Reduction in the number of blood cells.
Increased risk of infection.
Nausea.
Diarrhea.
Hair thinning or hair loss.
Stomatitis.
Fatigue.

Chemotherapy and radiotherapy

Radiation may be given at the same time as chemotherapy. The method is called chemoradiotherapy. Irradiation is given every weekday for 5 weeks.

Various methods of chemoradiation therapy are used. The patient may receive chemotherapy during the course of radiation. Sometimes a patient undergoes several cycles of chemotherapy before starting radiation therapy.

Chemoradiation therapy may be given before or instead of surgery. Several different chemotherapy drugs are used. The combination of cisplatin and Xeloda is most often recommended.

Cisplatin is given intravenously on an outpatient basis, sometimes requiring an overnight stay. Capecitabine tablets are taken twice a day for the entire course of therapy.

Radiotherapy is carried out every weekday for 5 weeks. Most patients undergo chemoradiation treatment for esophageal cancer on an outpatient basis, but hospitalization is sometimes required due to the negative effects of treatment.

Side effects of chemoradiotherapy

This type of treatment is quite intensive. Undesirable effects of chemotherapy and radiation may occur - a decrease in blood cells, increased fatigue, redness of the skin in the treatment area, nausea, sore throat, weight loss.

Nausea

Available effective drugs to eliminate this symptom.

Sore throat

Most patients who undergo this treatment have a sore throat. Swallowing problems may worsen as therapy continues. The doctor will prescribe painkillers and may recommend replacing solid food with liquid food for a while. Some patients use a pump to take analgesics, which provides a constant dose of medication and comfort throughout treatment for esophageal cancer.

Weight loss

Patients may lose weight due to problems with swallowing. Don't worry too much about this. If the situation is serious, the doctor may suggest placing a feeding tube (gastrostomy or jejunostomy) until the patient recovers from therapy and is eating normally.

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Radiation therapy for esophageal cancer

Radiation therapy uses ionizing radiation to treat cancer.

Doctors at the Assuta Clinic often use radiotherapy. A combination of cytotoxic drugs and radiation may be recommended to treat the disease, either before or instead of surgery. More often, this type of treatment for esophageal cancer is prescribed instead of surgery when the upper third of the esophagus is affected, especially with squamous cell carcinoma.

If the disease is diagnosed in advanced stages, radiation is also used. It can shrink the tumor and reduce the symptoms caused by the tumor.

External radiation therapy is predominantly used for esophageal cancer, but, in addition to it, internal brachytherapy is sometimes recommended, when a source of radioactive radiation is placed inside the esophagus.

During your appointment with the doctor at the Assuta clinic, you can ask any questions you may have. Sample list:

Why is radiotherapy recommended in this case?
What is its task?
Do you need external beam radiotherapy or brachytherapy, or both?
Is there a choice?
How long will the treatment take?
What are the possible short and long term side effects?
Is a special diet necessary for this period of time?
Is there anything the patient can do to alleviate the side effects?

External irradiation is carried out at the Institute of Radiation Therapy at the Assuta Clinic, mainly on an outpatient basis. The duration of the course depends on the goal of treatment of esophageal cancer in Israel - to cure the disease or reduce its manifestations.

Radiotherapy aimed at getting rid of esophageal cancer involves a course lasting from 4 to 6 weeks. The radiation oncologist will calculate the total radiation dose and divide it into smaller treatments called fractions.

It is possible to receive one fraction per day; treatment is carried out on weekdays until the total dose is given. Doctors prescribe radiation therapy to balance the side effects with the benefits of treating esophageal cancer.

Radiation therapy to control the manifestations of the disease involves receiving fewer fractions. This may be one treatment per day over several days, or a series of treatments with a few days between each.

Planning radiation therapy for esophageal cancer

Before treatment begins, the radiation oncology team carefully plans external radiation therapy. The total dose is calculated and the treatment area is determined. The planning process can take from a few minutes to two hours. A CT or MRI will be performed to precise definition tumor and structures around it.

The treatment area can be marked with special marks (tiny tattoos).

If the upper segment of the esophagus is affected, a mask will be needed to keep the patient still while treatment is being carried out.

It may take several days to work out the final details of the plan.

Receiving radiation therapy for esophageal cancer in Assuta

Linear accelerators have big sizes. The machine can be fixed in one position or rotated around the body, providing irradiation from different directions. The doctor explains to the patient in detail what will happen. The session takes from one minute to several. It is important to maintain the desired position.

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Brachytherapy in the treatment of esophageal cancer in Israel

Brachytherapy is a type of radiation therapy where the radiation source is located inside the body rather than outside from a linear accelerator. This type of treatment is not used as often as external beam radiotherapy. Typically, brachytherapy is used to slow the progression of a disease rather than cure it. For example, after installing a stent to make swallowing easier.

A radioactive source is placed inside the esophagus for a certain time. This delivers high doses of radiation directly to the tumor. Since radiation does not spread well through body tissue, surrounding healthy areas receive a significantly lower dose and are not seriously affected. The irradiation area is limited to approximately 1 cm around the radioactive source.

There are two methods used to provide this treatment for esophageal cancer in Israel through an endoscope or a nasogastric tube.

The doctor may place a radioactive source during the endoscopy. An endoscope, similar to a flexible telescope, is lowered into the throat. It is equipped with a light and a camera so the doctor can see the inside area. Before the procedure begins, the patient is given a sedative or mild anesthetic. A radioactive source is placed near the tumor. The radioactive material is sealed inside the tube so it cannot escape.

The same type of nasogastric tube is used. It is inserted through the nose and down the back of the throat to the stomach. The radioactive source is installed and the probe is removed.

Side effects of radiation therapy

Side effects are determined by the treatment area. When treating esophageal cancer, this area may extend to the middle of the chest.

Undesirable consequences include:

short-term pain when swallowing;
dry sore throat, which makes swallowing difficult;
increased fatigue;
redness skin in the processing area;
loss of body hair in the area of treatment.

Such phenomena usually arise gradually throughout the course and may intensify towards the end. The patient is usually able to eat only liquid or very soft foods by the end of therapy.

If nausea is observed, antiemetic drugs are prescribed. For most people, changes in the skin are minor; some have more problems.

Side effects of radiation therapy when treating symptoms

If secondary foci of the disease have arisen in the body, only a few procedures may be prescribed. Therefore, it is likely that there will be no adverse effects. Radiation therapy is aimed at improving the condition and well-being.

Side effects of brachytherapy

Brachytherapy also has certain undesirable treatment effects. It may cause painful sensations when swallowing. Sometimes ulcers occur inside the esophagus. The doctor will prescribe painkillers. During this period, liquid or very soft foods are recommended.

Long-term side effects of radiation therapy

Both internal and external radiotherapy can cause long-term consequences. For example, provoke a narrowing or stricture of the esophagus. This will make it difficult to swallow. Minor surgery (dilatation) may be performed to widen the organ. This is usually performed during an endoscopic procedure.

Targeted therapy for esophageal cancer

Targeted drugs help the body control the growth of malignant cells.

Herceptin in the treatment of metastatic esophageal cancer

For adenocarcinoma of the esophagogastric junction that has spread to other parts of the body, trastuzumab (Herceptin) may be recommended as the primary treatment for esophageal cancer. It is prescribed with chemotherapy.

Herceptin is effective only if there is a large amount of the her2 protein on the surface of cancer cells. Before prescribing therapy, genetic tests are performed.

Herceptin is prescribed in combination with cytostatics - cisplatin and capecitabine or fluorouracil. Herceptin cannot cure metastatic cancer, but trials show it improves survival for patients. The drug is administered intravenously every three weeks. This treatment for esophageal cancer continues as long as the disease is controlled.

Side effects of Herceptin

The most common adverse events include: fatigue, diarrhea, allergic reactions, skin rash. These symptoms can be managed with medications.

Herceptin can cause damage to the heart, so tests are done regularly to find out how well the organ is working.

Other targeted therapy drugs

Researchers are studying the drug Avastin (bevacizumab) for the treatment of cancer of the esophagus, including the gastroesophageal junction.

Prices for treatment of esophageal cancer in Israel

Consultation with a specialist – 600 dollars.
Gastroscopy with testing for Helicobacter pylori - $1080.
General blood test – 260 dollars.
PET-CT – 1670 dollars.
Biochemical analysis – 280 dollars.
Study of materials (biopsy) – 680 dollars.
Testing for tumor markers – $240.
Esophagoscopy – 370 dollars.
Ultrasound – 340 dollars.
Target Now – $9,250
Chemotherapy – 1180 dollars.
Medicines – from 360 dollars.
Radiation therapy – 140 dollars.
Esophagectomy – $59,000.
Complete resection – $75,000.
Partial resection – $59,000.

Finishing work about surgical treatment patients with esophageal cancer, it is impossible not to dwell at least briefly on the radiation method, which is widely used for the treatment of esophageal carcinoma.

Esophageal cancer - in which exposure to rays should produce good effect. Claire and Japha, Morrison believe that radiation treatment should be used for cancer of the upper two-thirds of the esophagus. Observations by Trautmann, Papillon, Goyon, Dufek, Lill, Dunlop, Barth, Kern and others show that radiotherapy for esophageal cancer has a palliative effect.

Dufek, Lill used radiotherapy in 56 patients. Of these, 83% died in the first year, no one lived to see 3 years of age, average term life was 6.7 months, while out of the 9 radically operated patients, one lives about 5 years.

Scheel, who used radiation treatment in 399 patients with esophageal cancer, reported that long-term results were poor: only two lived 5 years without recurrence. KbHer also received poor results: out of 296 patients with esophageal cancer, 55% had treatment interrupted due to elevated temperature and leukopenia, 81% of patients died by the end of the 1st year, after 2 years 3% are alive.

L. M. Goldstein, who used the method of long-term fractional irradiation through a non-displaceable lead grid, also noted that the treatment was palliative in nature; 75% of patients died within 1 year; none survived 5 years.

In our country, J. G. Dillon was one of the first to widely use radiation therapy for esophageal cancer. He used X-ray irradiation from many fields concentrically located around the lesion and obtained good immediate results. According to T. G. Larioshchenko and S. I. Alekseeva, who used Dillon’s technique in 58 patients, a good palliative result was observed in 28 and clinical direct cure in 15.

With the introduction of the rotational irradiation method into the practice of radiotherapy, both immediate and long-term results of treatment of patients with esophageal cancer have improved.

According to Gunning, of 88 patients treated with X-rays using the rotational method, 77 received the full course and 50 of them had no signs of the disease. After 3 years, 8 patients were healthy, after 5 years - 4, after 6 years - 1 patient. The author notes that the method was used in inoperable patients with any tumor location in the esophagus. If operable patients were irradiated, the results might be better.

Scharer reported the results of radiation treatment of 155 patients on a rotating table. Of these, 2% of patients were healthy for 5 years, 4% for 3 years; 17% experienced improvement, 4.5% died from metastases, and 57% had no changes or deterioration. 17 patients had bleeding, 34 had perforation of the esophagus. Scharer believes that compared to field irradiation, rotational treatment is slightly better.

A.I. Ruderman provides data on 302 patients with esophageal cancer who were subjected to rotational irradiation. Of 302 patients, clinical cure was observed in 37%, palliative effect in 39%. From the “clinically cured” group, 16% of patients lived for more than 2 years, 7% for more than 4 years, and 5 patients for more than 5 years.

Adler and Deeb reported that after the death of 2 patients with esophageal cancer 17 and 34 months after combined external and intracavitary treatment, no residual tumor could be detected during sectioning of the esophagus.

Since 1958, the first reports on the treatment of patients with esophageal cancer with radioactive cobalt-telegammatherapy appeared in the domestic literature. Currently, telegachimatherapy using the domestic GUT-Co-400 installation is used in many X-ray and oncology institutions in our country. A detailed study of both immediate and long-term results of treatment of patients with esophageal cancer is being carried out, the effect of this type of rays on the body is being studied, etc. Evidence of increased interest in telegammatherapy for esophageal cancer is a large number of works devoted to this issue.

1) from the stage of esophageal cancer,

2) from the irradiation technique,

3) from general condition patient, etc. Nevertheless, M.A. Volkova and G.A. Zedgenidze clearly note that the results of telegammatherapy are much better than radiotherapy.

According to Z. F. Lopatnikova, out of 200 patients treated, 24% live more than 2 years and 5% live more than 5 years. According to G. A. Zedgenidze, out of 214 patients exposed to radiation using the GUT-Co-400 installation, 117 lived longer

2 years old, 7 - 3 12 years old, 2 - about 7 years old. This top scores described in the domestic literature on radiation treatment of esophageal cancer. It should be noted that Z. F. Lopatnikova, in addition to external irradiation, in some cases also used the intracavitary method of gamma therapy. In addition, she prescribed chemotherapy drugs “to increase the effectiveness of treatment.”

The results obtained by I. A. Popova, V. P. Shakirova and L. I. Sergeeva are much worse. Despite the fact that, according to L.I. Sergeeva, of 130 patients with esophageal cancer who were under observation, 2 had stage I of the disease, 58 had stage II, 41 had stage III, and only 29 had stage IV, more than 2 years only 8 people lived.

Watson and Brown, using deep X-ray irradiation on 12 patients, noted that 5 of them were alive and healthy, and 7 died. Among the deceased, 4 had no signs of carcinoma at autopsy. The authors conclude that esophageal cancer can be cured with deep beam X-ray therapy.