Image - guided radiotherapy for esophageal cancer

Esophageal cancer is the eighth most common malignancy worldwide, with more than 480,000 new patients diagnosed annually. The incidence of esophageal adenocarcinoma is increasing, whereas the incidence of squamous cell carcinoma has not changed. According to the Surveillance, Epidemiology and End Results (SEER) statistics, the 5-year survival rate for esophageal carcinoma based on stage at diagnosis (2001–2007) is 17% overall: 37% for local disease; 18% for regional disease and 3% for distant disease [101]. Radical external beam radiotherapy plays an important role in the management of esophageal malignancies in the preoperative setting for operable patients [1,2], and as a definitive treatment for patients that are not resectable due to medical or technical considerations. This article will focus on the current status of CT-guided radiotherapy planning in esophageal malignancies; discussing the challenges in defining disease extent and spread with current multimodality imaging, methods of target definition for radiotherapy planning, characterization of tumor motion and current best practice for treatment set-up. Future perspectives and challenges in the implementation of new imaging for radiotherapy delivery will also be considered.