Follow-up/Toxicity

Question 1

What is the rate of esophageal stricture following RT alone & CRT?

Answer 1

For esophageal cancer, series of RT alone reveal benign strictures in 12%–30% of pts, and 1 series showed a 12% rate >1 yr after CRT (Adebahr S et al., Best Pract Res Clin Gastroenterol 2016). Balloon dilation is successful for ∼80%–90%.

Question 2

What types of toxicities are experienced during radiotherapy, and what measures should be taken to help minimize these toxicities?

Answer 2

Relief is obtained with topical anesthesia, narcotics, H2 blockers, feeding tube (J-tube if preop CRT, PEG if definitive CRT), and limiting the dose to critical structures.

Acute: esophagitis, skin irritation, fatigue, weight loss

Late: dysphagia, stricture, pneumonitis, laryngeal edema, cardiac injury, renal insufficiency, liver injury

Question 3

Describe an appropriate f/u schedule for pts after completion of Tx for esophageal cancer?

Answer 3

Majority of relapses within 2 yrs. F/u for esophageal cancer after Tx: H&P q3–6 mos for 2 yrs, q6–12 mos for next 3 yrs, then annually; at each visit, basic labs such as CBC/chemistry panel; consider CT chest/abd every 6 mos × 2 yrs, and if bimodality therapy EGD every 3–6 mos × 2 yrs, q6mos for 3rd yr, then as clinically indicated (NCCN 2018); and dilatation for stenosis and nutritional counseling as needed.