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What dose of radiation do you use for neoadjuvant chemoradiation in esophageal cancer?

The CROSS trial showed a survival benefit with 4140 cGy and concurrent carbo/taxol, but I was always trained to treat to 5040 cGy. Is anyone de-escalating the RT dose?
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In your experience, is 50.4Gy neoadjuvant dose for esophageal cancer associated with a higher rate of anastamotic leaks?

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4 Answers
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Radiation Oncology · Brigham and Women's Hospital
Answered on

The CROSS trial does not exist in a vacuum. We have a long history of esophageal trials by the RTOG and other cooperative groups that consistently used chemoradiation to 5040 cGy, and this remains the standard of care in the U.S. That said, if I have to treat a very long tumor, resulting in lung met...

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Radiation Oncology · Memorial Sloan Kettering Cancer Center
Answered on

I agree with @Dr. First Last's answer and 50.4 Gy is the standard preoperative dose at our center. I also agree with the other comments that this dose, since it is identical to the standard definitive dose for esophageal cancer, allows us to have delivered the recommended dose of RT to patients who ...

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Radiation Oncology · Precision Radiation Oncology
Answered on

If normal tissue constraints can be met, I always try to achieve a dose goal of 50.4 Gy. That way, if for some reason, the patient is unable to undergo the planned surgical resection, he will have received a definitive dose of RT. I usually will perform a cone down at 45 Gy to help limit dose to the...

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Radiation Oncology · Radiation Medicine Associates
Answered on

I think its crucial to note the role of biology here. The CROSS trial was overwhelmingly adenocarcinomas, whereas the historical trials have been majority squamous cell carcinoma. As such, i think a simple rule of thumb is to look at the chemo. the med/oncs will usually based choice of chemo on hist...

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