Radiation esophagitis is a common entity in those patients receiving external beam radiation therapy for a thoracic malignancy and is often the dose limiting toxicity in these patients. The mucosal lining of the esophagus is damaged and can lead to sloughing and ulceration with significant discomfort, possible infection and more rarely perforation. An indirect sign of radiation-induced esophagitis is the decreased marrow uptake seen in the thoracic vertebral bodies immediately posterior to the affected region of the esophagus. The vertebral bodies (and any marrow site within the radiation port) will demonstrate decreased uptake for some time following radiation and in some cases may be permanent.

Preventive measures:
Amifostine is a cyto-protective agent used to limit radiation induced injury and protect the mucosal lining of the esophagus. This may decrease uptake. It does not have a tumor protective effect however.