Radiation therapy in the postoperative management of esophageal cancer

The optimal management of esophageal cancer is complicated since institutional preferences vary, patient characteristics often guide management, and there are data to support multiple approaches for locally advanced esophageal cancer. Although surgery is an important component of therapy, alone it results in unacceptably high rates of local relapse and poor long-term survival rates. Well-studied adjuvant approaches include upfront chemoradiation therapy with or without surgery, perioperative chemotherapy, adjuvant radiation or adjuvant chemoradiation. This review article seeks to examine thoroughly the role of postoperative therapeutic options for the management of esophageal cancer, and in so doing, also overviews prospective trials in the neoadjuvant, definitive and perioperative settings. Studies evaluating radiation field design are also discussed.