Radiation Therapy for Esophageal Cancer

NYU Langone doctors may use radiation therapy, in which energy beams are used to destroy cancer cells in a noninvasive manner, to treat esophageal cancer. It is often combined with chemotherapy, which makes the radiation more effective, in an approach called chemoradiation.

Doctors may recommend radiation therapy or chemoradiation before surgery to help shrink tumors and prevent the recurrence of cancer after surgery. They may also prescribe these treatments after surgery to help rid the body of any remaining cancer cells.

Radiation therapy can be an option for people who cannot have surgery, either because the cancer is too advanced or they are in poor health. Doctors may also use radiation to help relieve symptoms of esophageal cancer, such as pain or difficulty swallowing.

Radiation Oncologist Dr. Alec Kimmelman Reviews Images with Staff

Dr. Alec Kimmelman reviews radiology images with staff.

With any of these approaches, our radiation oncologists carefully target the tumor, avoiding damage to nearby organs, such as the heart, lung, and spine.

Treatment Planning

Our radiation oncologists use advanced imaging of the tumor and the surrounding tissue and organs—in conjunction with computer-based treatment planning software—to develop a customized treatment plan.

This software creates a three-dimensional image of the esophageal tumor and the surrounding organs and enables our doctors to determine how best to target the cancer while sparing healthy tissue.

Image-Guided Radiation Therapy

Throughout treatment, our physicians may perform frequent CT scans, which use X-rays and a computer to create cross-sectional, three-dimensional images of the esophagus and surrounding structures.

This helps to ensure that the radiation therapy targets the esophageal cancer and avoids other important tissues. This approach, called image-guided radiation therapy, helps to compensate for the natural movement of your organs while you’re breathing.

Types of Radiation Therapy

NYU Langone physicians may use one of several types of external beam radiation therapy. Each of these therapies is delivered using a machine called a linear accelerator, which rotates around you, treating the entire tumor.

Typically, sessions take place once daily, five days a week, for several weeks, although the total treatment time may vary. Our doctors may also use brachytherapy, also called internal radiotherapy, which releases targeted radiation inside the body.

Each type of radiation therapy detailed below is more highly targeted than the previous one. Radiation oncologists can discuss which type of radiation therapy and treatment schedule is best for you.

Three-Dimensional Conformal Radiation Therapy

Three-dimensional conformal radiation therapy allows doctors to deliver radiation beams tailored to the size, shape, and location of the tumor.

Using imaging techniques such as CT or PET/CT scanning, oncologists create a three-dimensional model of the cancer. They can then aim radiation beams at the tumor from different directions, minimizing radiation to healthy tissue.

Intensity Modulated Radiation Therapy

Intensity modulated radiation therapy is a more highly targeted form of radiation therapy. Doctors break up the radiation into many smaller, computer-controlled beams of different strengths. Together, these minibeams conform to the size, shape, and location of the tumor. Physicians can adjust them within millimeters to spare surrounding healthy tissue.

This approach enables doctors to use higher doses of radiation therapy when necessary.

Volumetric Modulated Arc Radiation Therapy

Another type of intensity modulated radiation therapy, volumetric modulated arc radiation therapy allows the linear accelerator to move continuously around you during the treatment in 1 or several 360-degree rotations. This allows doctors to deliver radiation from almost any angle, closely targeting the tumor and avoiding healthy tissue.

Physicians can also adjust the radiation beams during treatment, instead of starting and stopping, as with conventional therapy. Because the radiation is given without interruption, treatment sessions may be shorter than more conventional approaches.


Brachytherapy involves placing high doses of a radioactive substance called an isotope against the tumor for a few minutes at a time. It is removed after each treatment.

Doctors use an endoscope, a thin, lighted tube with a video camera on the end, to guide the radioactive isotope to the tumor site.

Managing Side Effects of Radiation Therapy

Our doctors carefully adjust the dose of radiation therapy to prevent or lessen temporary side effects, such as difficulty swallowing, coughing, fatigue, and nausea.

NYU Langone nutritionists can help you adjust to any dietary changes, such as needing to eat easy-to-swallow foods, that may occur as a result of esophageal cancer treatment.