1. Dr. Lokesh Viswanath M.D
Professor
Department of Radiation Oncology
Kidwai Memorial Institute of Oncology
19-07-2015
2. Introduction
ď Radiotherapy forms an important component of
management of esophageal cancer both in the curative
as well as palliative intent of treatment
3. Indication for RT
Resectable cancer:
ď as pre-operative concurrent chemo-radiotherapy
ď as postoperative radiotherapy - in positive cut margins, nodal positivity and
presence of residual disease.
unresectable cancer: concurrent chemo-radiation is the current standard of
care
advanced & metastatic disease: palliative radiotherapy is offered either by
external beam or brachytherapy.
4. RT Settings
Radical RT Palliative RT
External RT Brachytherapy : ILBT ď Ext RT
ď ILBT
Key Factors influencing RT
decisions:
1. KPS
2. Magnitude of dysphagia
3. Nutritional status
4. Estimated tolerance to
Oncotherapeutics
5. Co-existing
1. Disease conditions:
impending TOF
2. Organ / adj structure
infiltrations
6. medical conditions
1. Pulmonary
2. cardiac
Radical RT :
ď Ext RT Alone
ď Ext RT + Brachy
ď RT + Radiation Sensitizer
O2 CDDP 5FU Taxanes others Biological
ADJ RT:
ď Pre OP RT +/- Radiation Sensitizer
ď Post OP RT +/- Radiation sensitizer
Others
ď Intra OP RT
32. Over all Survival (%) 2YRS 3YRS 5YRS
SURGERY ALONE 15.4 20.8 18
THE 25.3
TTE 19.9
RT ALONE 16 10.5
CRT 30 26
CRT 50 40
CRT 65 31
PRE OP CT > S 37.6 17.6
PRE OP RT > S 22
PRE OP CRT > Surgery
NON RCT 44 41 34 *
RCT 34 39 *
POST OP RT
NO 38
N+ 34
RT+NIMOTUZUMAB 33.3 26.2
egfr+++ 46 38.5
egfr++ 28.6 28.6
RT + CT + C225 44
RT + CT 42