I am a 3+ year survivor of Stage IV ESCC. I am totally non-PO due to extensive esophageal strictures. I've undergone 10 dilation but my esophagus is now too friable to attempt further dilations as it would repture. I am totally dependent upon my G tube for meds, nutrition and hydration. I was treated with aggressive chemo-radiation to try to control my disease. Unfortunately, one of rarely discussed side effects of radiation therapy for esophageal, throat and head and neck cancers is reactive fibrosis. While radiotherapy kills the cancer, it also produces free radical reactive oxygen species (ROS) and inflammation which cause tissue fibroblasts near the cancer lesion to produce increased amounts of connective tissue. This results in increased tissue stiffness and rigidity as well as strictures. The throat and esophagus may be amenable to dilation but the relief may be temporary as fibrosis and strictures inevitably recur. For severe fibrosis and large strictures, surgery is generally not advisable or effective as the tissue is generally friable and there may be too little viable tissue for effective healing.

This is an unmet medical need for esophageal, throat and head and neck cancer patients. I wish that radiation oncologists, oncologic surgeons and gastroenterologist would explore the use of co-administration of various antifibrotic agents, approved or experimental, to determine whether they might reduce or prevent radiation induced fibrosis and stricture formation.