Adjuvant therapy for postoperative esophageal cancer can be classified as sequential therapy, combined radiotherapy, or adjuvant radiotherapy alone. If your doctor thinks that your body is tolerating it well, he or she will usually recommend that you choose combined radiotherapy, also called synchronized radiotherapy.
Clinically, some patients are concerned about the side effects when they are told they are going to receive combined radiotherapy and are afraid that they will not be able to withstand the “double whammy” of chemotherapy and radiotherapy.
I hope you understand that both radiation and chemotherapy are important in the treatment of esophageal cancer. If you are tolerating it well, then concurrent radiotherapy is the first choice. Synchronous radiation and chemotherapy combine the benefits of both treatments, making “1+1 better than 2”.
Synchronous radiotherapy for locally advanced esophageal cancer has been shown to have a 5-year survival rate of 26%, compared with 0% for radiotherapy alone. This means that about 1 in 4 patients treated with concurrent radiotherapy will be cured, whereas few patients treated with radiotherapy alone will be cured.
The risks during combined radiotherapy, including myelosuppression, gastrointestinal reactions, radiation esophagitis, and radiation pneumonitis, are undeniable, and the incidence of these toxic effects is somewhat heavier than with radiotherapy alone.
But rest assured that your doctor will evaluate your health in a comprehensive manner and weigh the pros and cons through physical examinations and pre-treatment examinations. If your doctor determines that you are physically intolerant to combined radiotherapy, he or she will choose sequential radiotherapy, radiotherapy alone, etc. for you. If you are still in good health, it is not recommended that you choose to have only radiotherapy or chemotherapy because you are concerned about too many side effects.
Co-written by: Dr. Rong Yu Dr. Jing You, Peking University Cancer Hospital