Definitive chemoradiotherapy with simultaneous integrated boost of radiotherapy dose for T4 esophageal cancer—will it stand for a standard treatment?

Esophageal cancer has been recognized as a dismal disease because it metastasizes even in the early stage and invades vital organs, such as the trachea and aorta. Despite advancements in multidisciplinary treatment, consisting of chemotherapy (CT), radiotherapy (RT), and surgery (1), no standard treatment for T4 esophageal cancer has been established. Although definitive chemoradiotherapy (dCRT) has been considered one of the treatment options, a high recurrence rate was observed even after the patients achieved clinical complete response (cCR). Based on previous findings that most local failure occurred within the radiated field (2), Welsh et al. planned to evaluate whether intensive local treatment using a simultaneous integrated boost of RT (SIB-RT) could improve local control and survival.