Radiotherapy for cancers of the oesophagus, gastroesophageal junction, and stomach

Oesophageal and gastric cancers are associated with a poor prognosis, as diagnosis is often delayed in fragile, comorbid patients. Radiotherapy plays a pivotal role in the treatment of oesophageal cancer. It is indicated in combination with chemotherapy for squamous cell carcinoma and for locally advanced, inoperable adenocarcinoma (i.e., non-operable patients or unresectable tumours). Additionally, chemoradiotherapy may be proposed in the preoperative setting for squamous cell carcinoma or for adenocarcinomas when peri-operative chemotherapy is not feasible. For resectable gastric adenocarcinomas, the indications for radiotherapy are limited. However, radiotherapy may be useful in a palliative setting in case of dysphagia or bleeding. Recent technological advances, such as image-guided radiotherapy and conformal intensity-modulated radiotherapy, have considerably improved the tolerance of treatments, particularly in curative approaches. These innovations optimize target volume coverage while limiting toxicity on adjacent organs at risk, notably the heart and lungs. We present here the updated guidelines of the Société française de radiothérapie oncologique (SFRO) regarding the indications and technical modalities of radiotherapy for oesophageal and gastric cancers.