Chemoradiotherapy for oesophageal cancer

When do you have chemoradiotherapy?

Treatment with chemotherapy and radiotherapy together is called chemoradiotherapy.

Chemotherapy uses anti cancer (cytotoxic) drugs to destroy cancer cells. The drugs circulate throughout the body in the bloodstream.

Radiotherapy uses high energy x-rays to treat cancer cells.

Giving these treatments together can cure some early stage oesophageal cancers. Chemoradiotherapy can also shrink a cancer before surgery to make it easier to remove.

Your treatment plan depends on:

• how far your cancer has grown (the stage)

• what type of oesophageal cancer you have (adenocarcinoma or squamous cell cancer)

• how well you are

Your doctor will discuss your treatment plan with you and ask you to sign a consent form.

Chemoradiotherapy as your main treatment

You might have chemoradiotherapy instead of surgery if you have a squamous cell cancer that hasn't spread. The doctors keep a close eye on you after the treatment. This is called active surveillance. 

Chemoradiotherapy before surgery

You might have chemoradiotherapy before surgery if your cancer hasn't spread to other parts of your body. This is called neo adjuvant chemoradiotherapy. It shrinks the cancer and makes it easier to remove.

Chemoradiotherapy instead of surgery

You might have other health conditions that mean you're not well enough to have surgery. Or you might not be able to have surgery because the cancer has grown into nearby tissues. The doctor might offer you chemoradiotherapy instead.

Chemotherapy treatment

You usually have a combination of 2 chemotherapy drugs with radiotherapy.

The usual combinations are:

• cisplatin and capecitabine

• paclitaxel and carboplatin

• cisplatin and fluorouracil

• fluorouracil and oxaliplatin

You might start the chemotherapy before the radiotherapy starts. You continue to have it during the radiotherapy treatment.

You have most chemotherapy drugs for oesophageal cancer into your bloodstream (intravenously). Capecitabine is a tablet.

You usually have treatment in the chemotherapy day unit. Or you might need to stay in hospital overnight. 

Read more about the chemotherapy drugs you might have

Read more about chemotherapy for oesophageal cancer

Radiotherapy treatment

You have radiotherapy using a machine that is outside of your body. This is called external radiotherapy. You have treatment each day for five days a week. Your treatment lasts between 4 and 6 weeks. You have it in the hospital radiotherapy department.

Before you begin radiotherapy, you have a CT scan to plan your treatment. The scan shows the cancer and the area around it. At your planning appointment, the radiographers might make pen marks or small tattoos on your skin in the treatment area. The plan they create is just for you.

Your treatment starts a few days or up to 3 weeks after the planning session. 

When you have treatment your radiographers line up the radiotherapy machine using the marks on your skin.

Then they leave you alone in the room for a few minutes for the treatment. This is so they aren't exposed to radiation. You need to lie very still. The machine makes whirring and beeping sounds. You won’t feel anything when you have the treatment.

This type of radiotherapy won't make you radioactive. It's safe to be around other people, including pregnant women and children.

Find out more about radiotherapy treatment for oesophageal cancer

Tests

You have blood tests before and during your treatment. They check your levels of blood cells and other substances in the blood. They also check how well your liver and kidneys are working.

DPD deficiency

Between 2 and 8 out of 100 people (2 to 8%) have low levels of an enzyme called dihydropyrimidine dehydrogenase (DPD) in their bodies. A lack of DPD can mean you’re more likely to have severe side effects from capecitabine or fluorouracil. It might take you a bit longer to recover from the chemotherapy. These side effects can rarely be life threatening.

Before starting treatment with capecitabine or fluorouracil you have a blood test to check levels of DPD. So you may start treatment with a lower amount (dose) of the drug or have a different treatment. Your doctor or nurse will talk to you about this.

Find out more about having a DPD deficiency

Side effects

Most people will have some side effects from chemoradiotherapy for oesophageal cancer. Combining chemotherapy and radiotherapy can make side effects worse. But everyone is different and the side effects vary from person to person. You might not have all the effects mentioned. 

Side effects depend on:

• how well you are before treatment

• which chemotherapy drugs you have

• how much of each drug you have

• the dose of radiotherapy

• how long you have your radiotherapy treatment for

The side effects gradually get worse during the treatment. They can continue to get worse after your treatment ends. But most of the effects begin to improve after 1 or 2 weeks.

Tell your healthcare team about any side effects you have. There are things they can do to help.

Contact your doctor or nurse if any of the side effects are severe.  Or contact them if your temperature goes above 37.5°C or below 36oC. Infections can make you very unwell very quickly.

Chemotherapy side effects

Common chemotherapy side effects include:

• feeling sick

• loss of appetite

• losing weight

• feeling very tired

• increased risk of getting an infection

• bleeding and bruising easily

• diarrhoea and constipation

• hair loss

Read more about the general side effects of chemotherapy

Radiotherapy side effects

Common radiotherapy side effects include:

• tiredness and weakness

• pain

• difficulty swallowing

• feeling or being sick

• hair loss

• voice changes

• reddening of the skin

Read more about the side effects of radiotherapy