Toxicity management for acute radiation esophagitis

Authored by Nina Sanford, published on 2026-02-22 16:22:54.0

How Dr. Nina Sanford, Associate Professor and Chief of Gastrointestinal Radiation at UT Southwestern manages acute radiation esophagitis after radiation therapy (RT) and stereotactic body radiation therapy (SBRT). Originally posted on YouTube "Managing Toxicity from Radiotherapy to Upper GI Cancers (esophagus, pancreas, liver)" by Dr. Sanford. 

  1. Acute Radiation Esophagitis
    • Patient on RT or ≤3 weeks after RT start
      • Dysphagia / Odynophagia / Retrosternal pain?
        • YES
          • Start PPI (pantoprazole 40 mg daily)
            • Soft, non-acidic diet
              • Add mucosal coating:
                • Magic mouthwash before meals • Sucralfate liquid 1 g 3–4x/day
    • During SBRT → SBRT
      • Nausea/vomiting
        • Continue
          • During SBRT →
            Start PPI + Sucralfate prophylaxis
          • Add prochlor-prepazine
            (brartang v – r/o ulcer/fistula
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