Submucosal Lipiodol Injection to Guide Radiotherapy for Esophageal Cancer

Radiotherapy for esophageal cancer relies on cross-sectional imaging to identify the entire extent of tumor. Rarely, the exact limits of the tumor may be radiologically occult. Lipiodol is a contrast agent which has been used successfully to mark cancers of the bladder and lung for radiotherapy and surgical resection. We report a patient with an adenocarcinoma of the gastroesophageal junction with tiny tumor implants extending proximally along the length of the esophagus, which were not visible on standard cross-sectional imaging studies. The proximal extent of implants was marked endoscopically using a submucosal injection of lipiodol, and this provided for adequate planning and successful delivery of radiotherapy.