Carol L. Kornmehl, MD

An ounce of prevention is worth a pound of cure. This maxim applies to people  who receive radiation therapy for cancers of the gastrointestinal tract as well  as the head and neck area. 

Unlike chemotherapy that is distributed throughout the entire body, radiation  therapy is a local treatment, meaning it affects only the area of the body  receiving radiation. In people receiving treatment to the head and neck area,  side effects include mouth sores and a sore throat. In those who undergo  radiation therapy to the gastrointestinal tract, side effects can include  nausea, diarrhea, and inflammation of the esophagus, the tube that connects the  mouth to the stomach. These side effects may persist for weeks following the  completion of radiation. Consequently, these people can incur difficulties in  swallowing food or fluids and/or holding them down, leading to weight loss,  dehydration, and malnutrition.

It is easier to minimize a decline in nutritional status than it is to  reverse malnutrition. In fact, a recent study looked at the effects of  nutritional intervention in 54 patients who received radiation therapy for the  aforementioned diagnoses. A registered dietitian assessed their dietary intake  of protein, calories, and fiber at the onset of treatment and at four, eight,  and 12 weeks. The nutritional intervention group, which was counseled to follow  the American Dietetic Association’s medical nutrition protocol, was compared  with patients receiving standard care without a special diet. 

As it turned out, the nutritional intervention group consumed significantly  more calories and protein than those of the standard group. Also, more people in  the intervention group were well nourished and fewer were found to be  malnourished than in the standard group. In addition, the nutritional  intervention group experienced a substantially smaller decrease in (and faster  recovery of) quality of life and physical function.

Despite the small number of study participants, patients should take away the  importance of a registered dietitian for radiation therapy patients with  gastrointestinal and head and neck cancers, as well as other cancers. The  dietitian will evaluate the person’s baseline nutritional status and implement  dietary intervention prior to the person’s radiation therapy. This way, patients  who already are malnourished or at high risk for becoming so will receive  individualized support from the dietitian from the beginning.

Nutritional care should continue throughout radiation therapy and for at  least one year after the completion of treatment. The good news is that by being  proactive with diet, radiation therapy patients can favorably influence their  quality of life.

Dr. Kornmehl is a board certified radiation oncologist and author of The  Best News About Radiation Therapy (

Articles

An ounce of prevention is worth a pound of cure.

Nutritional Counseling During Radiation Therapy

Radiation-induced esophagitis, the inflammation of the esophagus, is an unpleasant but temporary side effect of radiation therapy. Esophagitis is common in people who receive radiation therapy to the chest area for cancer of the esophagus as well as other cancers, including lung cancer and lymphoma.

Esophagitis feels like an  internal sunburn and usually develops two to three weeks after the initiation of  radiation therapy. In addition, the person might feel a sharp, burning pain or  food getting stuck in the chest when swallowing.

The cells that form the lining of the esophagus renew themselves rapidly and are vulnerable to chemotherapy and radiation. Unlike chemotherapy, which affects the entire body because it is distributed throughout the bloodstream, radiation only affects the body structures within the irradiated area.

Esophagitis is more common in people who receive chemotherapy immediately prior to and/or during radiation. The longer the radiation field (the area of the body receiving radiation), the more the esophagus is included and the greater the incidence of esophagitis. And the higher the daily dose of radiation, the more likely it is the person will develop esophagitis.

A lower daily dose of radiation can reduce the severity and likelihood of esophagitis, and keeping the length of the field as confined as possible is helpful. When it is necessary to treat a long field, giving a planned break of one week halfway through the treatment is prudent.

A commercially available drug called Ethyol (amifostine), which is a radiation protector, can be administered via injection 30 minutes prior to each radiation treatment. This can reduce radiation esophagitis and has been studied most extensively in the setting of lung cancer. Extending its use to other situations is under investigation.

The goals of treating esophagitis are to keep the person comfortable and to maintain nutrition, body weight, and fluid intake. High-calorie liquids, puddings, and custards are good choices. Softening one’s diet, avoiding extremely hot or cold foods, and refraining from alcohol and spicy food is the first step in alleviating the discomfort of esophagitis.

Prescriptions are available to numb, coat, and reduce inflammation in the esophagus. Pain medication can also be prescribed. Occasionally, people develop a fungal infection of the esophagus, which is treated with an antibiotic. Typically, radiation therapy is not interrupted.

Once radiation is completed or suspended, esophagitis usually resolves uneventfully within two to four weeks. The person can resume a regular diet, and esophagitis is not likely to recur.

Radiation-induced  esophagitis, the inflammation of the esophagus, is an unpleasant but temporary  side effect of radiation therapy. 

Carol L. Kornmehl, MD

Nutritional Counseling During Radiation Therapy

Esophagitis: A Common Radiation Side Effect

Latest News