Indications for radiotherapy in patients with esophageal cancer

Radiotherapy is one of the conventional methods for treating esophageal cancer, and its efficacy is also good. The indications for radiotherapy of esophageal cancer are relatively broad. Except for esophageal perforation forming esophageal fistula, distant metastasis, obvious cachexia, and severe diseases of the heart, lung, liver and other organs, radiotherapy can be performed. The specific indications for esophageal cancer are as follows:

1. Patients who are unable to or unwilling to undergo surgery due to concurrent medical diseases such as heart disease, hypertension, etc. when esophageal cancer is in its early stages or can be surgically removed.

2. If the patient has no local supraclavicular lymph node metastasis and no vocal cord paralysis, preoperative radiotherapy can be used first, which will help improve the surgical resection rate.

3. Patients with advanced esophageal cancer who are not suitable for surgery can receive radical radiotherapy, concurrent chemoradiotherapy, or late-course hyperfractionation/accelerated hyperfractionation/concurrent hyperfractionation chemotherapy.

4. Patients with residual lymph nodes after surgery can undergo postoperative radiotherapy.

5. Patients meet cytological or pathological diagnostic criteria, especially those with superficial esophageal cancer.

6. Preoperative radiotherapy for cervical esophageal cancer.

7. Patients with esophageal cancer who have no pre-perforation signs and no significant chest or back pain.

Tips: Pre-perforation signs of esophageal cancer:

1. Spike protrusion: The lesion site protrudes like a spike, the small one is like a burr, and the large one is like a wedge.

2. Niche formation: a larger ulcer.

3. Diverticular change: The formation is similar to that of general esophageal diverticulum and often occurs after radiotherapy.

4. Twisted into an angle: The esophageal wall loses its normal course, like the dislocation of a long bone after a fracture.

5. Mediastinitis: The mediastinal shadow widens, the patient's body temperature rises, the pulse speeds up, and there is chest and back pain. The prognosis after perforation is very poor, and most patients die within a few months.