Radiotherapy for esophageal cancer in Japan

Currently, surgery is the most popular treatment method for esophageal cancer. Radiation is not main treatment but only a supporting one. This situation is now changing because of chemoradiotherapy (CRT). In the 1980s, although most patients treated with radiotherapy were inoperable for extremely advanced or some medical reasons, treatment outcome of surgery was undoubtedly superior to that of radiotherapy. Low-dose rate radiotherapy has many biological benefits. We tried low-dose rate telecobalt therapy (LDRT) as a boost to improve the outcome of radiotherapy for esophageal cancer. However, the LDRT did not improve survival. Since 1990s, studies have demonstrated the effectiveness of CRT using cisplatin and 5-fluorouracil. We made a prospective comparison of surgery and CRT with salvage surgery after recurrence for operable esophageal cancer. Five-year survival rates of 75 CRT patients and 76 surgery ones were 67.5 and 57.7 %, respectively. Twenty-eight patients in the CRT group underwent salvage surgery and 14 survived. Thirty-nine patients in the CRT group (52 %) survived, preserving their esophagus and their QOL was excellent. CRT with salvage surgery should be offered to all operable patients. After CRT, some patients complained severe radiation pneumonitis and myocardial disease. Radiation field should be as small as possible, including the low-dose area. Dose distribution of proton and heavy particle therapies is superior to ordinary radiotherapy. In future, particle beam therapy alone or in combination with photon beam therapy will become widespread as a radiotherapy method during CRT for esophageal cancer.