Esophageal cancer: Treatment challenges and controversies

Abstract

The poor outcomes of esophageal malignancies in terms of local control and survival rates have perplexed radiation oncologists since long time. Chemoradiation has been recognized as a key definitive treatment modality with outcomes comparable to that of surgery. It offers a potential radical treatment option to patients unfit for surgery with the advantage of organ preservation. However, a clear consensus in terms of indications, dose schedules, and techniques of radiation is lacking. In pre- and post-operative settings, lower dose schedules of radiation are recommended. Some evidences suggest that patients receiving radical dose of radiation may derive survival benefit from increased doses. Low-quality emerging evidence suggests promising outcomes with brachytherapy but it needs to be testified further. A detailed review of the existing literature might help to address the controversies in clinical practice.