Radiotherapy for Oesophageal Cancer in the United Kingdom: Patterns of Practice and Quality Indicators

There is limited guidance relating to the provision of radiotherapy for patients with oesophageal cancer. Given this, we sought to assess variation in patterns of care in the UK and to devise quality improvement metrics to support future treatment standardisation.

We undertook a cross-sectional survey using a bespoke online survey to explore geographical variation in radiotherapy use for oesophageal cancer across the United Kingdom (UK) National Health Service (NHS). These data were combined with an observational registry analysis using the National Disease Registration Service Radiotherapy Dataset to explore temporal variation in radiotherapy utilization from January 2020 - June 2024.

Survey responses were received from 75% (n = 45/60) of UK centres. These demonstrate considerable variation in the interpretation of radiotherapy indications, particularly in the non-curative setting, as well as in radiotherapy technique; with, for instance, one third (n = 15/45) of centres reporting that they do not use motion management strategies for lower third or junctional tumours. Induction chemotherapy use differs between centres and by concurrent regimen, with 93-96% (n = 42-43/45) of centres using induction treatment prior to concurrent platinum/fluoropyrimidine and 56-62% (n = 25-28/45) using it prior to concurrent platinum/taxane. Post-treatment surveillance and follow-up measures also differed with little evidence for more intensive surveillance in patients fit for salvage resection. Most centres reported the use of intensity modulated or volumetric arc therapy (IMRT/VMAT) for radical plans, which was supported by NDRS data demonstrating that the median proportion of patients in each centre treated using IMRT/VMAT increased from 60% (range 14.3-100%) in January-June 2020 to 91.7% (range 16.7-100%) in January-June 2024.

There is substantial variation in the radiotherapy-based care of patients with oesophageal cancer in the UK. Formal national guidance is required to build on the quality metrics outlined here.