Radiotherapy for Esophageal Adenocarcinoma

  • Dora L. W. KwongEmail author
  • K. O. Lam
Part of the Methods in Molecular Biology book series (MIMB, volume 1756)


Adenocarcinomas occur in distal esophagus and often involve esophagogastric junction. Radiotherapy plays a key role in treatment, often in combination with chemotherapy and surgery in multi-modalities management. For resectable esophageal primaries, neoadjuvant chemoradiotherapy plus surgery can downstage disease and improve outcome over surgery alone. For patients with unresectable primaries or medically unfit for surgery, definitive chemoradiotherapy was found to improve survival over radiotherapy alone. For patients who had residual disease or involved margins after primary surgery, adjuvant chemoradiotherapy in postoperative setting was shown to improve local control and survival. Palliative radiotherapy can also be used to relieve local symptoms like dysphagia or bleeding. Careful radiotherapy planning is required to ensure adequate dose to target volumes without overdose to normal organs.

Key words

Radiotherapy Esophageal adenocarcinoma Neoadjuvant Palliative Chemoradiotherapy 


  1. 1.
    Siewert JR, Marcus F, Werner M et al (2000) Adenocarcinoma of the esophagogastric junction: results of surgical therapy based on anatomical/topographic classification in 1,002 consecutive patients. Ann Surg 232:353–361CrossRefGoogle Scholar
  2. 2.
    Rice TW, Ishwaran H, Ferguson MK et al (2016) Cancer of the esophagus and esophagogastric junction: an eighth edition staging primer. J Thorac Oncol 12:36–42CrossRefPubMedPubMedCentralGoogle Scholar
  3. 3.
    Miller C (1962) Carcinoma of thoracic esophagus and cardia: a review of 405 cases. Br J Surg 49:507–522CrossRefGoogle Scholar
  4. 4.
    Shapiro J, van Lanschot JJ, Hulshof MC et al (2015) Neoadjuvant chemoradiotherapy plus surgery versus surgery alone for esophageal or junctional cancer (CROSS): long term results of a randomised controlled trial. Lancet Oncol 16:1090–1098CrossRefGoogle Scholar
  5. 5.
    Tepper J, Krasna MJ, Niedzwiecki D et al (2008) Phase III trial of trimodality therapy with cisplatin, fluorouracil, radiotherapy, and surgery compared with surgery alone for esophageal cancer: CALGB 9781. J Clin Oncol 26:1086–1092CrossRefPubMedPubMedCentralGoogle Scholar
  6. 6.
    Walsh TN, Noonan N, Hollywood D et al (1996) A comparison of multimodal therapy and surgery for esophageal adenocarcinoma. N Engl J Med 335:462–467CrossRefGoogle Scholar
  7. 7.
    Herskovic A, Martz K, al-Sarraf M et al (1992) Combined chemotherapy and radiotherapy compared with radiotherapy alone in patients with cancer of the esophagus. N Engl J Med 326:1593–1598CrossRefPubMedPubMedCentralGoogle Scholar
  8. 8.
    Yu E, Dar R, Rodrigues GB et al (2004) Is extended volume external beam radiation therapy covering the anastomotic-site beneficial in post-esophagectomy high risk patients? Radiother Oncol 73:141–148CrossRefGoogle Scholar
  9. 9.
    MacDonald JS, Smalley SR, Benedetti J et al (2001) Chemoradiotherapy after surgery compared with surgery alone for adenocarcinoma of the stomach or gastresophageal junction. N Engl J Med 345:725–730CrossRefGoogle Scholar
  10. 10.
    Vuong T, Szego P, David M et al (2005) The safety and usefulness of high-dose-rate endoluminal brachytherapy as a boost in the treatment of patients with esophageal cancer with external beam radiation with or without chemotherapy. Int J Radiat Oncol Biol Phys 63:758–764CrossRefPubMedGoogle Scholar
  11. 11.
    Rosenblatt E, Jones G, Sur RK et al (2010) Adding external beam to intra-luminal brachytherapy improves palliation in obstructive squamous cell esophageal cancer; a prospective multi-centre randomized trial of the International Atomic Energy Agency. Radiother Oncol 97:488–494CrossRefPubMedGoogle Scholar
  12. 12.
    Kong FM, Ritter T, Quint DL et al (2011) Consideration of dose limits for organs at risk of thoracic radiotherapy: atlas for lung, proximal bronchial tree, esophagus, spinal cord, ribs and brachial plexus. J Radiat Oncol Biol Phys 81:1442–1457CrossRefGoogle Scholar
  13. 13.
    Yang GY, McClosky SA, Khushalani NI (2009) Principles of modern radiation techniques for esophageal and gastresophageal junction cancers. Gastrointest Cancer Res 3(Suppl 1):S6–S10PubMedPubMedCentralGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2018

Authors and Affiliations

  1. 1.Department of Clinical Oncology, LKS Faculty of MedicineThe University of Hong KongPokfulamHong Kong

Personalised recommendations