How would you approach a patient with locally recurrent esophageal carcinoma who is s/p previous chemoRT and refuses salvage surgery?

There is little data to guide treatment in this situation and well founded fear of toxicity with repeat radiation. In a recent report from China, patients with locoregional recurrence after definitive treatment that involved RT had impressively longer OS with repeat RT to a median dose of 50 Gy. The median cumulative BED₁₀ was 135.53 Gy (range 96–168 Gy). Interestingly, the addition of chemotherapy to repeat RT did not improve survival over repeat RT alone. Repeat RT was associated with a 24% risk of pneumonitis. Repeat RT also increased the rate of TE fistula to 9% and the rate of pericardial/pleural effusion to 15%. Other reports have cited rates of esophageal stricture/fistula as high as 25% for a full course of repeat CRT.

A good option ...