In what situations, if any, do you offer postoperative radiation or chemoradiation for patients with squamous cell carcinoma of the esophagus?

A very pertinent question, especially as the pendulum has swung towards treating esophageal cancers with neoadjuvant therapy - indeed, it has been quite a few years since I have treated an esophageal cancer case adjuvantly. The way I think about it, is that what is good for neoadjuvant therapy is good for adjuvant therapy - that is my indications for adjuvant therapy are large bulky tumors, lymph node involvement or close/positive margins. Also, I pay particular attention to upper esophageal cancers - sometimes because cervical anastomotic failures are not surgically salvagable without high morbidity. There were a series of studies in ths 1990s demonstrating local control benefit for adjuvant radiation, which is critical for patient perform...

While in the US/ Europe, the overwhelming approach for ESCC is neoadjuvant chemoradiation +/- surgery (our institution uses surgery only for incomplete response to chemoradiation based on the German/French data), in Asian countries, where the relative percent of squamous cell carcinomas is higher than the US and patients are often times screened, they tend to do more adjuvant chemoradiation. In fact, any given year at ASTRO for the past several years, there have been nice presentations addressing questions about target volumes and control rates for adjuvant chemoradiation. Because the disease burden is so high, there are big retrospective studies looking at this. There is a nice one recently published in the Annals of Surgery (Hwang et al 2...