Modern Management of Esophageal Cancer: Radio-Oncology in Neoadjuvancy, Adjuvancy and Palliation

Abstract

The modern management of esophageal cancer is crucially based on a multidisciplinary and multimodal approach. Radiotherapy is involved in neoadjuvant and adjuvant settings; moreover, it includes radical and palliative treatment intention (with a focus on the use of a stent and its potential integration with radiotherapy). In this review, the above-mentioned settings and approaches will be described. Referring to available international guidelines, the background evidence bases will be reviewed, and the ongoing, more relevant trials will be outlined. Target definitions and radiotherapy doses to administer will be mentioned. Peculiar applications such as brachytherapy (interventional radiation oncology), and data regarding innovative approaches including MRI-guided-RT and radiomic analysis will be reported. A focus on the avoidance of surgery for major clinical responses (particularly for SCC) is detailed.

Meta analysis of the second course of radiotherapy for recurrent esophageal cancer1

“…A total of 377 articles were obtained by searching database [18][19][20]. According to inclusion and exclusion criteria, 15 articles were finally included in this study, with a total of 956 patients, including 476 in observation and 480 in control.…”

A two-center experience: The impact of COVID-19 on two brachytherapy programs in Ontario - virtual care, service suspension and radiation therapy workflow

“…At Center 2, the management of esophageal cancer at the beginning of the pandemic was challenging, especially for those with severe dysphagia. Intraluminal BT, which involves placing a long applicator directly inside the a hallow organ such as the esophagus [22] , is one radiation modality recommended due to its rapid relief of symptoms [23] . In Center 2, where no AGMPs were allowed, the esophagus HDR BT program was on hold from April 1 to August 5, 2020.…”

The application of radiomics in esophageal cancer: Predicting the response after neoadjuvant therapy

“…Most established models have not been used for routine clinical treatment, and there is a lack of sizeable external validation ( 49 ). The disciplines behind it may still seem immature because of the inconsistent standards, heterogeneous methods, and quality control, which often does not exist ( 50 , 51 ). In summary, as an emerging field, radiomics has excellent potential to improve health care, mainly providing a solid foundation for clinicians or radiologists to develop cancer treatment strategies.…”