For oesophageal or oesophagogastric junction cancer, radiation therapy may be indicated as part of:

• neoadjuvant therapy before surgery
• definitive chemoradiotherapy for locally advanced disease in patients who are not able to undergo surgery (e.g. medical comorbidity or patient choice)
• palliation in symptomatic individuals with advanced or metastatic disease such as dysphagia, pain and bleeding in advanced oesophagogastric cancer.

For gastric cancer, radiation therapy may be indicated:

• postoperatively in combination with chemotherapy in selected patients who have undergone a gastrectomy for locally advanced gastric cancer
• in the palliative setting, before or after chemotherapy for palliation of symptoms.

Timeframes for starting treatment

Treatment should begin within two weeks of the MDM.

Training and experience required of the appropriate specialists

Radiation oncologist (Fellow of the Royal Australian and New Zealand College of Radiologists [FRANZCR] or equivalent) with adequate training and experience with an agreed scope of practice within this area.

The training and experience of the radiation oncologist should be documented.

Health service unit characteristics

To provide safe and quality care for patients having radiation therapy, health services should have these features:

• linear accelerator (LINAC) capable of image-guided radiation therapy (IGRT)
• dedicated CT planning
• access to MRI and PET imaging
• automatic record-verify of all radiation treatments delivered
• a treatment planning system
• trained medical physicists, radiation therapists and nurses with radiation therapy experience
• coordination for combined therapy with systemic therapy, especially where facilities are not co-located
• participation in Australian Clinical Dosimetry Service audits
• an incident management system linked with a quality management system.