Radiation Therapy

Radiotherapy is indicated for the treatment of esophageal cancer, both with curative intent and with palliative intent. Concurrent chemoradiotherapy (CRT) is the standard treatment for patients in good condition who can receive chemotherapy, based on the results of a randomized trial comparing CRT with radiotherapy alone. For locally advanced unresectable esophageal cancer, definitive CRT is standard therapy with potentially curative intent. And for resectable esophageal cancer, definitive CRT 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 CRT. However, high mortality rate of salvage surgery and high incidence of late toxicities after CRT with higher radiation doses are important problems to be solved. Neoadjuvant CRT is the standard treatment for locally advanced esophageal cancer in Western countries, whereas in Asia, it has not demonstrated a significant survival benefit compared with preoperative chemotherapy. Prophylactic CRT for patients with pT1b or pT1a involving lymphovascular invasion after endoscopic resection could be a treatment option from favorable results of a clinical trial. Combination chemotherapy of new agents and new radiotherapy techniques, such as intensity-modulated radiation therapy, proton-beam therapy, and heavy-particle radiotherapy, have been evaluated in clinical trials to improve the treatment results, including efficacy and toxicity.