Radiation therapy in upper GI tract tumours

Radiation therapy, with or without chemotherapy, may at moderate dose levels palliate more than half of the patients with unresectable upper gastrointestinal cancer. It appears as if this therapy prolongs the median survival in these patient groups, particularly if concomitant chemotherapy is given for at most a few months. However, controlled studies are lacking. Extremely few patients will be long-term disease-free survivors even if higher dose levels are used. Since local recurrences are common after apparently radical surgery, additional radiotherapy could increase the number of long-term survivors provided the dose level is sufficiently high. This has, however, never been properly investigated. Apart from palliation in symptomatic patients with non-resectable disease, radiation therapy should be "investigational", preferably in comparison with a "no-active treatment" arm. The effects of combinations of radiation and chemotherapy should be the object of further controlled studies. Local non-resectable disease is a major problem in all upper gastrointestinal tumours. It is common both primarily and after apparent radical surgery and it causes much suffering for these patients. Radiotherapy is a local therapy and has therefore gained considerable interest in these diseases. The possibilities of contributing significantly to the treatment is, at least to a certain extent, hampered by several factors, such as the often large size of the tumour and the radiosensitivity of the surrounding tissues.