title: [Radiotherapy in cancers of the oesophagus, the gastric cardia and the stomach].
abstract: Localized oesophageal and gastric cancers have a poor prognosis. In oesophageal cancer, external radiotherapy combined with concomitant chemotherapy is accepted as part of the therapeutic armamentarium in a curative intent in the preoperative setting for resectable tumours; or without surgery in inoperable patients or non-resectable tumours due to wide local and/or regional extension. Data from the literature show conflicting results with no clinical evidence in favour of either a unique dose protocol or consensual target volume definition in the setting of exclusive chemoradiation. In the preoperative setting, chemoradiotherapy has become the standard in oesophageal cancer, even though there is no evidence that surgery may be beneficial in locally advanced tumours that respond to radiotherapy and chemotherapy. The main cause of failure after exclusive chemoradiotherapy in oesophageal cancer is locoregional relapse suggesting that doses and volumes usually considered may be inadequate. In gastric cancer, radiotherapy may be indicated postoperatively in patients with resected tumours that include less than D2 lymph node dissection or in the absence of perioperative chemotherapy. Preoperative chemoradiotherapy in gastric cancers is still under investigation. The evolving techniques of external radiotherapy, such as image-guided radiotherapy (IMRT) and volumetric modulated arctherapy (VMAT) have reduced the volume of lung and heart exposed to radiation, which seems to have diminished radiotherapy-related morbi-mortality rates. Given this, quality assurance for radiotherapy and protocols for radiotherapy delivery must be better standardized. This article on the indications for radiotherapy and the techniques used in oesophageal and gastric cancers is included in a special issue dedicated to national recommendations from the French society of radiation oncology (SFRO) on radiotherapy indications, planning, dose prescription, and techniques of radiotherapy delivery.
authors: Département d'oncologie radiothérapie, centre Georges-François-Leclerc, 1, rue du Professeur-Marion, 21000 Dijon, France; CNRS, UMR6306 Le2i, allée Alain-Savary, 21000 Dijon, France. Electronic address: gcrehange@cgfl.fr.
authors: G
authors: G
authors: Créhange
authors: Service d'oncologie radiothérapie, hôpital Tenon, hôpitaux universitaires Est-Parisien, Assistance publique-Hôpitaux de Paris, 4, rue de la Chine, 75020 Paris, France.
authors: F
authors: F
authors: Huguet
authors: Service d'oncologie radiothérapie, hôpital Saint-Louis, Assistance publique-Hôpitaux de Paris, 1, avenue Claude-Vellefaux, 75010 Paris, France.
authors: L
authors: L
authors: Quero
authors: Département de radiothérapie oncologique, Siric Socrates Gustave-Roussy, Cancer Campus, 114, rue Édouard-Vaillant, 94800 Villejuif, France.
authors: T V
authors: TV
authors: N'Guyen
authors: Département d'oncologie radiothérapie, centre Oscar-Lambret, 3, rue Frédéric-Combemale, 59000 Lille, France.
authors: X
authors: X
authors: Mirabel
authors: Service de physique médicale, centre Oscar-Lambret, 3, rue Frédéric-Combemale, 59000 Lille, France.
authors: T
authors: T
authors: Lacornerie
mesh_terms: D000230:Adenocarcinoma / Q000532:radiotherapy* / Q000628:therapy; D001918:Brachytherapy / Q000379:methods; D002299:Cardia; D059248:Chemoradiotherapy; D059186:Chemoradiotherapy, Adjuvant; D003131:Combined Modality Therapy; D019583:Dose Fractionation, Radiation; D004938:Esophageal Neoplasms / Q000532:radiotherapy* / Q000628:therapy; D016629:Esophagectomy / Q000379:methods; D004943:Esophagogastric Junction; D005743:Gastrectomy / Q000379:methods; D006801:Humans; D015182:Lymphatic Irradiation; D008207:Lymphatic Metastasis; D058958:Organs at Risk; D011785:Quality Assurance, Health Care; D011832:Radiation Injuries / Q000517:prevention & control; D011878:Radiotherapy / Q000009:adverse effects / Q000379:methods / Q000592:standards; D011879:Radiotherapy Dosage; D011880:Radiotherapy Planning, Computer-Assisted; D061089:Radiotherapy, Image-Guided / Q000379:methods; D013274:Stomach Neoplasms / Q000532:radiotherapy* / Q000628:therapy
keywords: Cancer de l’estomac; Cancer de l’œsophage; Chemoradiotherapy; Chimioradiothérapie; Gastric cancer; Guidelines; Oesophageal cancer; Recommandations