Current landscape of radiation oncology in esophageal cancer: a narrative review

BACKGROUND AND OBJECTIVE: Esophageal cancer is an aggressive disease that is the sixth leading cause of cancer-related death worldwide. The overall treatment paradigm for esophageal cancer has changed considerably over the past decade. This narrative review aims to summarize the current landscape of radiation oncology for esophageal cancer. METHODS: A systematic search of the MEDLINE/PubMed database and Clinicaltrials.gov was performed, focusing on studies published within the last 10 years. Our search queried “esophageal cancer [AND] neoadjuvant radiation” as well as “locally advanced esophageal cancer [AND] definitive radiation”. Our search resulted in 298 total references. These were manually reviewed, and only 58 references were within our scope of interest ranging from 2012–2022. KEY CONTENT AND FINDINGS: For resectable esophageal cancer, neoadjuvant chemoradiation followed by surgery has been defined as the standard of care over the past decade. In patients with incomplete response to neoadjuvant chemoradiation, the benefit of immunotherapy in the adjuvant setting has recently been established. Ongoing studies are examining whether perioperative chemotherapy may be equivalent to neoadjuvant chemoradiation in resectable esophageal adenocarcinoma. For locally advanced esophageal cancer, recent studies have failed to show a benefit with radiation dose escalation in an unselected population, although the use of early positron emission tomography (PET) response to guide dose escalation is currently being studied. Other ongoing studies aiming to improve outcomes in locally advanced esophageal cancer involve using proton beam therapy to reduce toxicity and combining immunotherapy or targeted therapies with chemoradiation to amplify response. CONCLUSIONS: Recent advances in radiation oncology may continue to improve outcomes for patients with esophageal cancer.