The SCOPE of definitive chemoradiotherapy in locally advanced esophageal cancer: what direction for the future?

Exclusive chemoradiotherapy (CRT) delivering 50 Gy over 5 weeks with cisplatin and fluorouracil-based chemotherapy is a cornerstone in locally advanced esophageal cancer or non-operable patients since the results of the pivotal study of US Intergroup RTOG-8501 (1). This trial has successfully demonstrated that some patients with esophageal carcinoma may be long-term survivors so that this treatment is now definitely accepted as curative (2). Nevertheless the prognosis is still very disappointing with a 5-year overall survival rate of approximately 25%. Attempts to improve overall survival by escalating the dose of radiotherapy with concurrent cisplatin and fluorouracil has been assessed in INT 0123 trial (3). Overall survival rate after 64.8 Gy was not superior or even lower to 50.4 Gy. This result precluded dose escalation in esophageal cancer for more than a decade. However, the results of these two studies established CRT with the 50.4 Gy dose as the standard of care in esophageal cancer.