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Radiation plays an important role in the management of multiple gastrointestinal malignancies including cancer of the esophagus, stomach, colon and rectum, anus, pancreas, and hepatobiliary tree. Gastrointestinal tumors frequently require a multidisciplinary approach for optimal management including surgery, radiation, and chemotherapy.
Cancers of the esophagus can be successfully treated with a combination of chemotherapy and radiation therapy alone or given pre or post-operatively. Types of radiation therapy used for esophageal cancer include 3-D conformal external beam radiation therapy and brachytherapy. Brachytherapy includes the use of an intraluminal isotope which allows a high dose of radiation to be delivered to a small volume of tissue. Brachytherapy can be given in the outpatient setting much as external beam radiation is given. (more on brachytherapy)
We have developed high treatment standards throughout the Saint Barnabas Health Care System (SBHCS) for esophageal cancer management. Such standards have been based on results of guidelines sanctioned by the American College of Radiology and are well supported by clinical studies. State-of-the-art treatment protocols for esophageal cancer are available at several SBHCS radiation facilities through their affiliation with the Radiation Therapy Oncology Group (RTOG) or the Fox Chase Cancer Center.
Gastric cancer is generally managed by surgical resection however often postoperative adjuvant treatment with radiation therapy combined with chemotherapy is required. Our 3-D conformal treatment techniques help maximize dose to the areas at risk for disease in the abdomen and minimize does to surrounding normal tissues such as bowel, kidneys, and liver.
Curability of cancer of the pancreas is predominantly determined by whether or not the tumor can be surgically resected. Following surgical resection, patients often require postoperative adjuvant chemotherapy and radiation therapy. Some patients may benefit from preoperative chemotherapy and radiation therapy and patients with unresectable disease can also benefit by combined chemotherapy and radiation therapy. Again, the use of 3-D conformal radiation therapy can help in minimizing side effects. National cooperative group trials such as those of RTOG examining newer combinations of chemotherapy and radiation therapy for pancreatic cancer are available at several of our SBHCS facilities.
Cancer of the rectum is a common and relatively curable gastrointestinal malignancy. In addition to standard postoperative treatment with chemotherapy and radiation therapy for patients with stage II and III disease, preoperative chemoradiation may also be recommended for certain tumor locations and size. Such preoperative treatment may allow for sphincter sparing surgery. Studies involving high-dose preoperative radiation are also available at several of our SBHCS facilities.
Cancers of the anus are uncommon but highly curable without major surgery. Patients can often be treated with combined chemotherapy and radiation therapy alone. Side effects of such treatment can be considerable and our institutions are able to offer sophisticated treatment planning techniques that help minimize side effects.
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