How do you treat localized esophageal carcinoma in patients who are unwilling or unable to undergo chemotherapy or surgery?

This is a question that comes up occasionally in clinic. My viewpoint is generally based on the prospective data that we have. Of course, the RTOG 85-01 study showed 0% long-term OS with definitive RT vs CRT. Additionally, the Intergroup 0123 study showed no evidence of improvement with higher doses of RT. Other dose escalation studies have generally shown the same thing, at least among Western patients. For these reasons, I tend to push for chemoradiation for these patients to the standard dose of 50.4 Gy. We treat neoadjuvantly with carboplatin and paclitaxel per the CROSS trial. Although we prefer to follow the PRODIGE5/ACCORD17 trial using FOLFOX in the definitive (non-surgical) chemoradiation setting, there are patients who are poor c...