Esophageal cancer management controversies: Radiation oncology point of view

Table 5 Complications of radiotherapy to esophagus and their management

Acute complications

Skin erythema: 0.5% hydrocortisone, flamazine cream

Hair loss: no treatment

Mucositis, odynophagia, loss of appetite, fatigue, generalized weakness, dysphagia, dehydration, malnutrition, intestinal obstruction: intravenous hydration, xylocaine viscus, feeding tube

Pneumonitis: prednisone, oxygen

Spinal cord L'hermitte sign: no treatment

Larynx hoarseness: prednisone

Fistula/erosion of great vessels, esophageal perforation: consult thoracic surgeons

Chronic complications

Fibrosis/hyperpigmentation of skin: no treatment

Lung fibrosis: oxygen

Esophageal stricture: begins at 3-4 mo. Incidence: 50 Gy 0.8%, 60 Gy 0.6%; 60 Gy + chemo 12%. Treat by dilatation and/or stent

Peptic ulcer: proton pump inhibitor

Chronic enteritis: anti-diarrhoeal, aminosalicylates, pentoxifylline and tocopherol, cholestyramine, antibiotics, corticosteroids, hyperbaric oxygen

Spinal cord myelopathy: hyperbaric oxygen, anticoagulation