Thoracic esophageal cancer

Radiation combined with chemotherapy is currently the standard approach for treating thoracic esophageal cancer, and in most cases, this treatment is coupled with esophagectomy. Several randomized trials have demonstrated that the trimodality approach (chemotherapy, radiation, and surgery) provides the best survival outcomes for patients with thoracic esophageal cancer. However, given the proximity of the heart and lungs to the treatment fields, treatment can be quite toxic and occasionally fatal. Radiotherapy dose distributions in normal tissue contribute to the morbidity of therapy, and dosimetric evidence and recent clinical evidence suggest that the use of advanced radiation techniques such as intensity-modulated radiation therapy can reduce the dose to organs at risk and hence the morbidity of treatment. This chapter summarizes this research and the approach taken at MD Anderson Cancer Center for treating thoracic esophageal cancer.