Gaining New Ground: The Evolving Role of Radiation Therapy in Esophageal Cancer

Radiation therapy (RT) in the management of esophageal cancer is evolving. Advances in systemic therapy have altered the role of RT as preoperative therapy in patients with resectable esophageal adenocarcinoma. However, RT continues to play a central role in nonoperative management for patients with squamous cell carcinoma, with mounting evidence in patients with esophageal adenocarcinoma. The combination of RT with immune checkpoint inhibitors remains an area of promise and ongoing investigation. In addition, ablative RT continues to show its utility in the management of patients with oligometastatic disease. Herein, we present a contemporary critical review of the evolving role of RT in esophageal cancer including as perioperative therapy, in combination with immunotherapy, its role in nonoperative management including the role of RT dose escalation in patients with cervical esophageal cancer, and its utility in the management of patients with oligometastatic disease.