[The role of radiotherapy in the management of esophageal cancer].

Surgery remains the standard radical therapy of esophageal cancer. Esophagectomy is accompanied by high proportion of morbidity and mortality, and on overall provides relatively poor results. Recently in esophageal cancer, radiation therapy has been more frequently combined with other modalities including chemotherapy and surgery. Survival benefit following preoperative chemoradiotherapy was demonstrated in only one randomized trial including patients with adenocarcinoma. Similarly, no survival benefit following postoperative chemoradiotherapy was demonstrated. Therefore, such two-modality strategies are not recommended as a standard management. Definitive radiotherapy is indicated in early-stage esophageal cancer patients not amenable to surgery because of comorbid conditions, in those who refused surgery, and in selected patients with locally advanced disease. Improved survival rates, yet at the expense of increased toxicity, were reported by the combining of radiotherapy with chemotherapy including 5-fluorouracil and cisplatin. Both brachytherapy and external beam radiotherapy are the main palliative approaches in patients with dysphagia.