Chemoradiotherapy for oesophageal cancer
Treatment with chemotherapy and radiotherapy together is called chemoradiotherapy. You might have this treatment for oesophageal cancer.
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.
When do you have chemoradiotherapy?
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.
Clare Disney (nurse): Hello, my name is Clare and this is a cancer day unit.
So when you arrive and you’ve reported into with the receptionist one of the nurses will call you through when your treatment is ready, sit you down and go through all the treatment with you.
Morning Iris my name is Clare, I am the nurse who is going to be looking after you today. We’re going to start by putting a cannula in the back of your hand and giving you some anti sickness medication. And then I am going to come back to you and talk through the chemotherapy with you and the possible side effects you may experience throughout your treatment, is that ok?
Before you have each treatment you’ll need to have a blood test to check your bloods are ok and you’ll also be reviewed by one of the doctors to make sure you’re fit and well for your treatment. Sometimes you’ll have the blood test taken on the day of your treatment other times you’ll have it the day before your treatment when you see the doctor.
Each chemotherapy is made up for each individual patient, depending on the type of cancer they have and where it is and depending their height, weight and blood results.
So, depending on where your cancer is some people have their chemotherapy drug, their cancer drug by drip, some will have an injection and other people will have tablets.
So, Iris your chemotherapy is going to be given to you in what we call cycles and the cycles are given every three weeks for a period of six cycles. So you will be coming in for approximately five months for your chemotherapy.
Depending on where your cancer is and what type of cancer you have will be dependent on how often you come in for treatment. An example of a treatment cycle would be for you to come in on Day 1, Day 8 and Day 15 then to have a week’s break before you come back again for Day 1 treatment.
Depending on the type of treatment that you are having we will also give you some anti sickness tablets to take alongside your chemotherapy and also some drugs to prevent any reactions if that’s appropriate.
All chemotherapy is given over different time periods so it’s best to check with your nurse about how long you are likely to be in the unit for. This can range from anything up to an hour to an all day treatment slot so please be prepared to bring along some bits to keep you occupied books and music.
So, before you go home it’s important to make sure you have got the tablets you need to go home with your anti sickness medications and any other symptom control tablets that you may require. Also, to make sure that you’ve got the telephone numbers for the oncology unit to phone if you have a temperature or you are experiencing any other symptoms at home that you need to ask advice about.
So, please make sure when you leave the unit that you’ve got all the information you require and if you’ve got any questions at all don’t hesitate to ask the nurse who will be able to answer them for you.
Before your next cycle of treatment you will come in and see the doctor in the clinic room, you’ll have a blood test and an examination to make sure you are fit and well for treatment you will then come back the following day or later on that week for treatment.
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.
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.
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
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
