The Radiotherapy of Locally Advanced Esophageal Cancer of Inoperable Forms with Escalated Dose of 66-70 Gy

Squoamous cell carcinoma and adenocarcinoma account for more than 90% of all esophageal cancer cases. The total dose recommended in the actual NCCN guidelines is 50.4 Gy in 1,8 Gy fractions for the treatment of an esophageal cancer, a dose who never cure a macroscopic tumor. We present here 3 clinical cases where we delivered 66-70 Gy in 2 Gy fraction and a local cure was obtained. We examine and describe critically the role of curative radiotherapy for the management of esophageal cancer or combined with other modalities. Each patient had a PET/CT examination before starting the curative treatment. We also describe and present the role of radiation technologies and the concept of target volume delineation for the different parts of the esophagus as extrathoracic, intrathoracic and the eso-gastric junction. We present clinical cases of extrathoracal, intrathoracal and an esophageal junction cancer who were treated with curative intent by applying a combined radiochemotherapy with a total dose of 66-70 Gy in 33-35 fractions. Despite of the data from the literature the local cure of an esophageal cancer in the extrathoracic, intrathoracic or at the eso-gastric junction by using IMRT technics and by applying a total dose of 66-70 Gy in standard fractionation is possible.