Changing role of radiotherapy in the management of cancer of the esophagus

Background. Cancer of the esophagus remains a highly lethal disease, but ne w treatment approaches that build onto traditional surgical and radiotherap eutic methods are making an impact on organ preservation while offering hop e for improved survival. Methods. Reviewed here are recent data from trials on the use of new radiot herapeutic approaches. Results, There is clinical trial evidence for improved treatment results wi th radiotherapy and concurrent systemic chemotherapy. For some patients wit h responsive cancers, the use of chemoradiation results in about 25% being cured-a marked departure from the results of treatment with radiotherapy al one in the preceding decades. This idea is being explored further with new trials using advanced radiotherapy treatment planning systems called "confo rmal therapy," in which the high irradiation dose envelope is designed to f it tightly around the cancer. Conclusions. Cancer of the esophagus can now be treated aggressively with c hemoradiation to offer a choice for local symptom control, organ preservati on, and cure.