Radiation Therapy

Abstract

Radiotherapy is indicated for the treatment of esophageal cancer both with curative intent and with palliative intent. Concurrent chemoradiotherapy is the standard treatment for patients in good condition who can receive chemotherapy, based on the result of randomized trial that compared chemoradiotherapy with radiotherapy alone. For locally advanced unresectable esophageal cancer, definitive chemoradiotherapy is the standard therapy with potentially curative intent. And for resectable esophageal cancer, definitive chemoradiotherapy is a treatment option in an attempt to preserve the esophagus from favorable results of clinical trials. These results are supported by salvage treatment in cases of residual or recurrent disease after chemoradiotherapy. However high mortality rate of salvage surgery and high incidence of late toxicities after chemoradiotherapy with higher radiation dose are important problems to be solved. Neoadjuvant chemoradiotherapy is standard treatment for locally advanced esophageal cancer in Western countries; however it is investigational in Japan. Combination chemotherapy of new agents and new radiotherapy technique such as intensity-modulated radiation therapy, protonbeam therapy, and heavy-particle radiotherapy have been evaluated in clinical trials to improve the treatment results including efficacy and toxicity.