It is a heterogeneous group of tumors as the digestive apparatus reaches all the entire digestive tube (esophagus, stomach, intestine, colon – rectum and anus) and, along with pancreas and liver.
Radiotherapy has a relevant role related or not to surgery and/or chemotherapy for the mostly part of localizations.
radioterapia externa (RTE) planning is carried out in TC done after place the patient in a positioning and casting system, chosing the most suitable depending on the treated area. The one that allows reproducing comfortably and firmly is choosing, the same position each day of the treatment. The esophagus cancer, gastric and esophageal-gastric join, the CT is done in supine (flat on one’s back), using IV contrast and/or oral in some cases.
It is used information provided by some or several of the following tests for localizing: panendoscopy, echoendoscopy, esophageal-gastroduodenal with barium radiological study (EGD) y PET-TC. The radiotherapy oncologist is who, after analysing each case, decides the necessary ones.
In rectum cancer, the common position for irradiating and, therefore, the operational in TC for planning, is prone (lying upside down) using the immobilization system of some type of device for excluding the intestine loops in radiation area. It is also possible to perform the CT planning supine (flat on one’s back) with a specific locking system The radiotherapy oncology specialist will be who determines the more suitable position according to the patient’s characteristics. Often, MR images (resonancia magnética) are used achieving a better definition of tumor spread.
In anal cancer , the position for the TC planning and treatment differs from each case, or supine (flat on one’s back) or prone. Both options, with the corresponding casting system letting the chosen position reproduction for each day of treatment.
For pancreas cancer, the radiotherapy position and the corresponding TC for planning is supine. It usually used intravenous and oral contrast and, often, images fusion are used of resonancia magnética (RM) and PET-TC for helping with the irradiation areas delimitation.
Once the planning CT acquisition is already completed, some marks are drawn in the treatment skin area. Thorax, for esophagus tumors cases; upper abdomen, stomach, pancreatic and liver cancer; and low abdomen, rectum tumors or anal region tumors, which will help to localize the coordinates to allow the radiotherapy administration in each session, as planned.
In esophagus cancer, the options are: Exclusive surgery, in early stages of tumor (unusual); the remaining, a multimodal treatment (radiotherapy and chemotherapy combination and depending on each case, an esophagectomy—removal of part or all the esophagus.) Also, the radiotherapy is indicated as palliative treatment.
The treatment is administered in lineal accelerator with a 3D technique or with Intensity-modulated radiation therapy (IMRT), in some cases it is used for CT cone-beam, previously controlled for Imaging Guided Radiotherapy (IGRT).
For some patients, it is suitable a brachytherapy – external radiotherapy combination. For brachytherapy, a digestive endoscopy specialist physician performs a esophagoscopy to visualize the tumor and allowing that the radiotherapist puts, in this tumor area, a catheter where a radioactive source is inserted the necessary while releasing the correct radiation dosage. Esta técnica de braquiterapia endoluminal permite administrar dosis elevadas en la zona del tumor y mínimas en los tejidos sanos adyacentes.
In stomach cancer, small and localized, the initial treatment often is surgery, related or not to postoperative chemotherapy or radio-chemotherapy. Its indication is decided by the medical team according to the tumor spreading. In local tumors more advanced, the option is usually preoperative chemotherapy or radio-chemotherapy or, in some cases, postoperative.
The treatment is administered in acelerador Lineal with a 3D technique or with Intensity-modulated radiation therapy (IMRT).
In early rectum cancer it is decided, mainly by surgery. If in the tumor study, it is confirmed that it is limited to the inner wall and with nodes affectation it is reinforces as the unique treatment. However, it is not infrequent to discover that the tumor is bigger, in that situation, the indicated postoperative treatment will be radiotherapy and chemotherapy. In patients with locally advanced tumors from the initial diagnosis, the treatment is multimodal. Commonly, it is started with radiotherapy and chemotherapy, simultaneously administered and in a preoperative way, so that, after few weeks after finishing it, the surgery is performed (removal of the remaining tumor or in the area where it was). In postoperative, chemotherapy administration is usual. If the patient has been operated without receiving previous treatment, radiotherapy and chemotherapy can be applied.
Radiotherapy is administered in acelerador lineal with 3D technique, and it also has a key role in patients with a few tumor metastases, when diagnosed in liver and lung, if surgical removal is feasible. A multidisciplinary treatment can be often proposed in these cases which start chemotherapy or radiotherapy with chemotherapy on the rectum tumor and, then, surgery with rectum tumor removal and liver and/or lung metastasis.
For patients with unresectable rectum tumors, radiotherapy in acelerador lineal with 3D technique aids to improve symptoms as pain or bleeding.
In these cases, is normally combined with chemotherapy.
To patients with pulmonary or hepatic metastasis surgical irremovable, stereotactic body radiotherapy can be applied (SBRT) with Cyberknife (treatment that allows to administer a high dosage, particularly in tumor, respecting as much as possible the healthy tissue. It has the benefit of no need of limiting casting of breath movement due to its capacity to fit the bundle of radiation incessantly to the tumor movement inside the lung or liver.)
In anal cancer, radiotherapy has a key role, as for early tumors as for locally advanced ones, since related to chemotherapy is the chosen treatment. Surgery involving abdominoperineal amputation and permanent colostomy (excision of all the area from the anus, closing its skin and colostomy bag, in abdomen area, for faeces), is for patients in whom control of tumor with radio chemotherapy is not reached.
Radiotherapy is administered in lineal accelerator normally with modulated intensity (IMRT).
When indicated, in some cases, it would be done a treatment withbraquiterapia.In pancreas cancer, if possible, a surgical excision and postoperative treatment with chemotherapy or radio chemotherapy are applied. If resection were not possible, and it is considered that the tumor might turn resectable after the preoperative treatment, a chemotherapy related to radiotherapy is used in some cases for try to remove it later. In unresectable tumors, the treatment is focused in chemotherapy and radiotherapy administration.
Radiotherapy is administered in lineal accelerator with 3D technique or IMRT.
For some patients stereotactic body radiotherapy (SBRT) is indicated with Cyberknife (treatment that allows a very high dosage administration, only to the tumor, with the maximum respecting to the healthy tissue around. In pancreas tumors cases we talk about organs as the small intestine, liver, stomach and kidneys.
Acutes: Sickness/vomits and pyrosis (burning sensation rising up to mouth) in localized treatments in the upper abdomen area (esophagus, stomach and pancreas). Diarrhea, vaginal irritation and urinary symptomatology by bladder and urethra irradiation.
Chronics: Intestine rhythm disturbances with more frequency of diarrhea disorders with constipation periods fundamentally in tumors of rectum and anus.