Radiation-induced Esophagitis in Lung Cancer—A Common Problem with Limited Therapeutic Options

Abstract

Radiation-induced esophagitis is a common toxicity of radiation therapy of the chest, characterized by disruption of the epithelium due to damage to the underlying basal cells. The frequency of radiation-induced esophagitis correlates with the dose of radiation the esophagus receives and the volume that is treated with that dose. Modern radiation techniques are decreasing the size of the treatment field, potentially reducing the incidence and severity of esophagitis; however, it remains an important concern in patients with lung cancer treated with chemoradiotherapy. The pathogenesis of esophagitis is similar to that of head and neck mucositis, but there have been very few trials of treatments for the prevention of radiation-induced esophagitis. Current research is limited to several natural products which have shown activity in small randomized trials. However, several agents are currently being tested in clinical trials for the treatment of radiation-induced esophagitis. A successful agent to reduce/prevent esophagitis may allow higher doses of radiation to be delivered to the cancer and increase the curability of localized lung cancer. This review highlights the current understanding and limitations of data in radiation-induced esophagitis and current and potential future approaches to treatment.