Radiation Esophagitis

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August 3, 2008 - 7:48 am email to a friend printer friendly view / write comments

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Dr. Mehta

   Esophagitis is a symptom that occurs in patients undergoing radiation for lung cancer.  It is not uncommon for patients to blame the radiation for this side effect.  Radiation esophagitis if often described as a “sunburn on the inside of the esophagus.”  The esophagus it the long swallowing tube that sits in the middle of the chest usually right next to the trachea (the windpipe).  The tube connects the mouth to the stomach.  Unfortunately, it is very difficult to avoid this structure when delivering radiation because it is intimately associated with the lung, central lymph nodes, and the trachea.  Avoiding the esophagus would mean undertreating the tumor in many instances.

   Patients who develop esophagitis will often complain of some heartburn like discomfort or pain with swallowing.  These symptoms come on gradually and get worse as they complete treatment.  They typically peak sometime after the radiation ends.  In the most severe form, an ulceration can form in the esophageal wall (this happens very rarely).

   There have been some studies that have been done that have specifically looked at the incidence and severity of esophagitis.  Most of these studies have tried to grade the esophagitis in terms of its severity.  A natural breakpoint in terms of severity is when a patient might require IV fluids (because they can’t drink due to pain) or a feeding tube (because they can’t eat due to pain).  This typically occurs in grade III esophagitis.  The early forms of esophagitis are a nuisance but can be managed with coating agents or pain medications.  Anyway, in many studies the incidence of grade III esophagitis is only about 2-4% in the patients that are receiving radiotherapy alone.  In the patients that are receiving chemotherapy at the same time, the incidence of grade III esophagitis jumps to 24+%.  This means that the chemotherapy must be making the normal esophageal cells more sensitive to the effects of radiation. 

   Radiation esophagitis or chemo/radiation esophagitis is a frequent complication of treatment.  It can be managed during treatment and it gradually gets better after treatment.  It is important to communicate to your treating physicians these sorts of symptoms so that they can give appropriate medications that can make you feel better.

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