The benefits of dose escalation in terms of both local control and survival have been demonstrated for tumors in other anatomic sites and could perhaps be applicable to esophageal cancer as well ( 4- 6). This finding suggests that current trimodality therapies are beneficial in some cases, but local disease control, specifically within the GTV, remains a problem. In a previous review of failure patterns among patients with unresectable esophageal cancer treated with chemoradiation therapy to 50.4 Gy, we found that 75% of those failures occurred within the gross tumor volume (GTV) ( 3). This may be a reflection of the difficulty in standardizing advance radiation technique among multiple institutions, making it difficult for our large cooperative groups to run the studies needed to answer these questions. Although radiation planning, tumor imaging, and radiation delivery have advanced rapidly over the past several decades, the radiation dose used to treat esophageal cancer has remained relatively unchanged. Trimodality therapy (surgery, chemotherapy, and radiotherapy) for esophageal cancer has improved patient outcomes, with radiotherapy believed to contribute to improvements in local control and survival ( 1, 2).
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