The vast majority of patients with esophageal cancer in China have squamous carcinoma, which is more sensitive to radiation and has better radiotherapy results. Therefore, radiation therapy and surgery are the two most important treatments for esophageal cancer side by side.
Understanding the place of radiotherapy in the treatment of esophageal cancer
Radiotherapy plays a pivotal role in the treatment of esophageal cancer, primarily for the treatment of locally progressive stages. This group of patients has often lost the opportunity for surgery and is often treated with a combination of radiotherapy or radiotherapy and chemotherapy.
Why do we add “chemotherapy” here? It is because radiotherapy is not a “lone wolf”, it is a collaborative effort, often working with other treatments to destroy cancer cells.
There are many different treatment modalities for radiation therapy, including synchronous radiation and chemotherapy, sequential radiation and chemotherapy, radiation alone, and preoperative or postoperative radiation in conjunction with surgery (i.e., neoadjuvant radiation therapy, adjuvant radiation therapy).
Radiotherapy can help three main categories of patients like this:
1. Patients who are older, physically unable to tolerate surgery, unwilling to “go under the knife”, and whose lesions are located in the cervical segment of the esophagus and cannot be removed can be treated with radiotherapy to destroy the tumor lesions;
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2. Radiotherapy is an option for patients with locally advanced esophageal cancer that is not amenable to surgery because of invasion of the esophageal lesions into surrounding organs;
3. For advanced patients with systemic metastases and local symptoms, radiotherapy can be used to reduce tumor-related symptoms, relieve eating difficulties, improve quality of life, and extend survival to a certain extent, which is generally referred to as “palliative radiotherapy.
Can radiotherapy replace surgery?
When it comes to treating tumors, many people may first think of surgery and chemotherapy, believing that surgery can take out the lesion and chemotherapy can destroy cancer cells on a large scale, while radiotherapy can only irradiate a small area and cannot take out the lesion, making the treatment incomplete.
This is actually not the case.
The first thing you should understand is that no one treatment can simply replace another in the treatment of esophageal cancer. Esophageal cancer treatment is a comprehensive treatment, and there is a treatment plan that is most suitable for patients with different stages and different physical conditions. When formulating a treatment plan, your doctor will combine multidisciplinary (including medical, surgical, radiotherapy, pathology, nutrition, etc.) consultations to choose the most appropriate treatment for you based on your physical condition and tumor stage.
Radiotherapy is an invisible scalpel that delivers a radical dose of radiation to the tumor lesion, achieving the goal of killing the tumor without either surgery or surgery.
Studies have shown that patients with locally advanced esophageal cancer have a 5-year survival rate of 20% to 30% after radiotherapy, meaning that patients who cannot be operated on have a chance of being cured with radiotherapy combined with other treatments.
How can I tell if I want to have radiotherapy?
Surgery for esophageal cancer is more difficult, more complicated, and more damaging to the body. Therefore, your doctor will strictly evaluate your physical condition. If you have no serious heart or lung disease, have an early stage tumor, and are evaluated by your doctor to be able to tolerate surgery, surgery is the preferred treatment option.
However, if you are not physically able to tolerate surgery or refuse surgery for personal reasons; or if the lesion is located in the cervical segment of the esophagus and is difficult to remove surgically and no distant metastases are found; or if the primary site is too advanced in stage to be removed cleanly by surgery, you may receive radiation therapy or radiotherapy.
Lastly, I would like to remind you that the choice of treatment requires a comprehensive assessment of your situation by your doctor, including: your general condition (physical condition, etc.); the stage of the tumor; the location of the tumor; whether you have any combined underlying diseases; whether you have had surgery before; etc. It is recommended that you choose a doctor you trust, cooperate with his treatment plan for you, and actively receive standardized treatment.
Co-written by: Dr. Rong Yu Dr. Jing You, Peking University Cancer Hospital