title: Radiation therapy and esophageal cancer.
abstract: BACKGROUND
  Squamous cell carcinoma and adenocarcinoma account for more than 90% of all esophageal cancer cases. Although the incidence of squamous cell carcinoma has declined, the incidence of adenocarcinoma has risen due to increases in obesity and gastroesophageal reflux disease.
  
  
  METHODS
  The authors examine the role of radiation therapy alone (external beam and brachytherapy) for the management of esophageal cancer or combined with other modalities. The impact on staging and appropriate stratification of patients referred for curative vs palliative intent with modalities is reviewed. The authors also explore the role of emerging radiation technologies.
  
  
  RESULTS
  Current data show that neoadjuvant chemoradiotherapy followed by surgical resection is the accepted standard of care, with 3-year overall survival rates ranging from 30% to 60%. The benefit of adjuvant radiation therapy is limited to patients with node-positive cancer. The survival benefit of surgical resection after chemoradiotherapy remains controversial. External beam radiation therapy alone results in few long-term survivors and is considered palliative at best. Radiation dose-escalation has failed to improve local control or survival. Brachytherapy can provide better long-term palliation of dysphagia than metal stent placement. Although three-dimensional conformal treatment planning is the accepted standard, the roles of IMRT and proton therapy are evolving and potentially reduce adverse events due to better sparing of normal tissue.
  
  
  CONCLUSIONS
  Future directions will evaluate the benefit of induction chemotherapy followed by chemoradiotherapy, the role of surgery in locally advanced disease, and the identification of responders prior to treatment based on microarray analysis.
authors.affiliation: Radiation Oncology Program, H Lee Moffitt Cancer Center & Research Institute, Tampa, FL 33612, USA. Ravi.Shridhar@Moffitt.org
authors.forename: Ravi
authors.initials: R
authors.lastname: Shridhar
authors.forename: Khaldoun
authors.initials: K
authors.lastname: Almhanna
authors.forename: Kenneth L
authors.initials: KL
authors.lastname: Meredith
authors.forename: Matthew C
authors.initials: MC
authors.lastname: Biagioli
authors.forename: Michael D
authors.initials: MD
authors.lastname: Chuong
authors.forename: Alex
authors.initials: A
authors.lastname: Cruz
authors.forename: Sarah E
authors.initials: SE
authors.lastname: Hoffe
mesh_terms: D000230:Adenocarcinoma / Q000188:drug therapy / Q000532:radiotherapy* / Q000601:surgery; D002294:Carcinoma, Squamous Cell / Q000188:drug therapy / Q000532:radiotherapy* / Q000601:surgery; D003131:Combined Modality Therapy; D004938:Esophageal Neoplasms / Q000188:drug therapy / Q000532:radiotherapy* / Q000601:surgery; D006801:Humans; D011878:Radiotherapy / Q000379:methods*; D011879:Radiotherapy Dosage; D016019:Survival Analysis; D016896:Treatment Outcome