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Esophageal cancer: comparative effectiveness of treatment options

Authors Xu C, Lin S

Received 30 November 2015

Accepted for publication 22 January 2016

Published 13 April 2016 Volume 2016:6 Pages 1—12


Checked for plagiarism Yes

Review by Single-blind

Peer reviewers approved by Dr Bik-Wai Bilvick Tai

Peer reviewer comments 3

Editor who approved publication: Dr Corrine I Voils

Cai Xu,1 Steven H Lin2

1Department of Radiation Oncology, Cancer Hospital and Institute, Chinese Academy of Medical Sciences Peking Union Medical College, Beijing, People’s Republic of China; 2Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA

Abstract: Esophageal cancer is a lethal disease. Multimodal therapy has improved the survival and local control for locally advanced esophageal cancer compared to surgery alone. Neoadjuvant chemoradiotherapy (CRT) plus surgery is the accepted standard of care for operable esophageal cancer. Pathologic complete response is very common, ranging from 18% to 43%, and it is an independent favorable prognostic factor for survival. Salvage surgery after definitive CRT may be safe and feasible for patients with esophageal cancer who achieve pathologic complete response after neoadjuvant CRT. For inoperable cases, definitive CRT is an alternative treatment modality. Intensity-modulated radiation therapy may reduce treatment-related toxicities due to its better dose homogeneity and conformity compared to three-dimensional conformal radiotherapy. Proton therapy can further improve target conformity and normal tissue sparing when compared to photon therapy (three-dimensional conformal radiotherapy and intensity-modulated radiation therapy) and, therefore, likely to further improve the treatment outcomes of patients. This article compares the effectiveness of the various treatment approaches in the definitive or neoadjuvant setting and reviews the evidence on the benefit of utilizing advanced radiation techniques for the curative management of esophageal cancer.

Keywords: esophageal cancer, treatment modalities, comparative effectiveness, IMRT, proton therapy

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