Guidelines for Radiotherapy of Esophageal Carcinoma (2020 Edition)

Abstract

Esophageal carcinoma is a high-incidence malignant tumor in China, ranking sixth and fourth highest in morbidity and mortality, respectively. Radiotherapy plays an important role in the comprehensive treatment of esophageal carcinoma. Standardized diagnosis and treatment based on the suggestions of a multidisciplinary team (MDT) form its foundation. For operable esophageal carcinoma, surgery after neoadjuvant chemoradiotherapy is the standard treatment; contrarily, for inoperable esophageal carcinoma, radical chemoradiotherapy is the only treatment option, and postoperative adjuvant radiotherapy can improve local control and survival rates in selected cases. Owing to the rapid technological development in radiotherapy, three-dimensional conformal radiotherapy, intensity-modulated radiotherapy, and image guidance technology are widely used in the treatment of esophageal carcinoma. Though drugs for treating cancer have been developed rapidly, we need to explore their optimal combination with radiotherapy, including chemotherapy, targeted or immune, and radiosensitizers.Esophageal carcinoma in China differs greatly from that in European and American countries in terms of etiology, pathological type, highincidence site, etc. Therefore, the European and American guidelines on radiotherapy for esophageal carcinoma cannot be applied in clinical practice in China. This gap was addressed when the 2019 edition of This is an open access article under the terms of the Creative Commons Attribution-NonCommercial License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited and is not used for commercial purposes.

Utilization and Outcomes of Radiation in Stage IV Esophageal Cancer

“…The recommended dose for palliation is itself a bit variable, with a range of 20 to 40 Gy across the guidelines. 3 , 4 , 5 , 8 , 13 , 14 , 15 , 16 In the current study, 64.8% of the patients who received radiation received less than 45 Gy, 29% received between 45 and 59.9 Gy, and 2.2% received considerably more radiation (60–80 Gy).…”

“…These categories were chosen to represent ranges for palliative and definitive dosing of external beam radiation therapy. 3 , 4 , 5 , 13 , 14 , 15 , 16 In a manner consistent with previous studies, 17 , 18 age was included as a categorical variable (18–34, 35–49, 50–64, 65–79, ≥80 y). Survival models with age as a continuous variable were created as sensitivity analyses, yielding similar results (data available on request).…”

“…For example, esophagitis, pneumonitis, myocarditis, and hematologic complications are common sequelae of radiation. 5 Furthermore, alternate treatments are available to palliate symptoms from primary esophageal cancers. Esophageal stents, cryotherapy, photodynamic therapy, or even cytotoxic chemotherapy may accomplish many of the goals of palliative radiation.…”

A Diagnostic Quandary: Carboplatin-Paclitaxel-Induced Stevens-Johnson Syndrome in a Rare Case of Carcinosarcoma of the Esophagus and Review of the Literature

“…Esophageal stenting can be done to relieve dysphagia and improve quality of life. Common sites of distant metastases include lungs, pleura, liver, brain, and bone, with greater tumor size at diagnosis being a poor prognostic factor [ 3 , 7 , 8 ].…”

“…Adjuvant fluorouracil-based chemotherapy and chemoradiotherapy are recommended in lymph node-positive patients, keeping node-negative patients on regular monitoring. Recent trials have suggested the use of immunotherapy like pembrolizumab, camrelizumab, and nivolumab in concurrence with chemotherapy or second-line agents [ 8 , 10 ].…”