Esophageal Adenocarcinoma Methods and Protocols

7

Alfred K. Lam (ed.), Esophageal Adenocarcinoma: Methods and Protocols, Methods in Molecular Biology, vol. 1756,
https://doi.org/10.1007/978-1-4939-7734-5_2, © Springer Science+Business Media, LLC 2018

Chapter 2

Radiotherapy for Esophageal Adenocarcinoma

Dora L. W. Kwong and K. O. Lam

Abstract

Adenocarcinomas occur in distal esophagus and often involve esophagogastric junction. Radiotherapy
plays a key role in treatment, often in combination with chemotherapy and surgery in multi-modalities
management. For resectable esophageal primaries, neoadjuvant chemoradiotherapy plus surgery can
downstage disease and improve outcome over surgery alone. For patients with unresectable primaries or
medically unfit for surgery, definitive chemoradiotherapy was found to improve survival over radiotherapy
alone. For patients who had residual disease or involved margins after primary surgery, adjuvant chemora-
diotherapy in postoperative setting was shown to improve local control and survival. Palliative radiotherapy
can also be used to relieve local symptoms like dysphagia or bleeding. Careful radiotherapy planning is
required to ensure adequate dose to target volumes without overdose to normal organs.

Key words Radiotherapy, Esophageal adenocarcinoma, Neoadjuvant, Palliative, Chemoradiotherapy

1 Introduction

Adenocarcinomas of the esophagus usually occur in the distal

esophagus proximal to or involve the esophagogastric junction.

The epithelial lining changes from stratified keratinizing squamous

epithelium to glandular epithelium at the esophagogastric junc-

tion. Adenocarcinoma at the esophagogastric junction is associated

with reflux esophagitis and Barrett’s esophagus. Barrett’s esopha-

gus is the replacement of squamous epithelium with columnar epi-

thelium. Endoscopically, the visible junction of the squamous and

glandular epithelium is known as the Z-line, which also defined the

esophagogastric junction.

According to Siewert, tumor that involves the esophagogastric

junction can be classified into three types according to the location

of the tumor epicenter. Tumor center that is located at more than

1 cm, up to 5 cm above the esophagogastric junction is considered

type I. Tumor that is centered at 1 cm proximal and 2 cm distal to

esophagogastric junction is considered type II. Tumor that is cen-

tered at more than 2 cm distal to esophagogastric junction is type III

[ 1 ]. In the proposed eighth edition of American Joint Committee