Official reprint from UpToDate®
www.uptodate.com ©2016 UpToDate®

Management of locally advanced unresectable and inoperable esophageal cancer

Dwight E Heron, MD, MBA, FACRO, FACR
Michael K Gibson, MD, PhD, FACP
Section Editors
Richard M Goldberg, MD
Kenneth K Tanabe, MD
Deputy Editor
Diane MF Savarese, MD


Management of patients with unresectable or inoperable esophageal cancer is challenging and requires a multimodality approach. This is a heterogeneous group that includes patients with potentially resectable (T4a, (table 1)) and unresectable (T4b) primary disease [1], poor surgical candidates, and those who decline surgery. (See "Diagnosis and staging of esophageal cancer", section on 'TNM staging criteria'.)

Prolonged progression-free survival (PFS) is possible in a minority of these patients; however, control (which we herein label as "palliation," or "palliative”" modalities) rather than cure of the cancer is the treatment goal for the majority, and quality of life (QOL) issues generally take precedence. Major goals of therapy are restoration and/or maintenance of the ability to swallow, management of pain, and prevention of bleeding.

To achieve these goals, a variety of therapies may be used, including external beam radiation therapy (RT) with or without chemotherapy, esophageal dilatation and/or stenting, photodynamic therapy (PDT), laser ablation, chemical ablation, and palliative surgery.

Optimal palliation usually requires the integration of two or more of these modalities, either concurrently or sequentially. While combined modality therapy offers a small but real chance of prolonged PFS and, potentially, prolonged overall survival, improvement in QOL and sustained relief of dysphagia can be achieved in the majority of patients. However, the durability of symptom palliation is variable.

This topic focuses on locoregional therapy for locally advanced, inoperable esophageal cancer. The roles of palliative surgery and RT without or with concurrent chemotherapy will be covered as well as an overview of endoscopic procedures for palliation of swallowing (dilation, stenting, PDT, and laser ablation). Other approaches to localized esophageal cancer and metastatic disease, as well as a more detailed discussion of endoscopic palliation, are provided in other topic reviews. (See "Surgical management of resectable esophageal and esophagogastric junction cancers" and "Radiation therapy, chemoradiotherapy, neoadjuvant approaches, and postoperative adjuvant therapy for localized cancers of the esophagus" and "Multimodality approaches to potentially resectable esophagogastric junction and gastric cardia adenocarcinomas" and "Systemic therapy for locally advanced unresectable and metastatic esophageal and gastric cancer" and "Endoscopic palliation of esophageal cancer" and "Use of expandable stents in the esophagus", section on 'Efficacy'.)


Subscribers log in here

To continue reading this article, you must log in with your personal, hospital, or group practice subscription. For more information or to purchase a personal subscription, click below on the option that best describes you:
Literature review current through: Sep 2016. | This topic last updated: Sep 16, 2016.
The content on the UpToDate website is not intended nor recommended as a substitute for medical advice, diagnosis, or treatment. Always seek the advice of your own physician or other qualified health care professional regarding any medical questions or conditions. The use of this website is governed by the UpToDate Terms of Use ©2016 UpToDate, Inc.
  1. American Joint Committee on Cancer Staging Manual, 7th, Edge SB, Byrd DR, Compton CC, et al (Eds), Springer, New York 2010. p.103.
  2. Ilson DH, Saltz L, Enzinger P, et al. Phase II trial of weekly irinotecan plus cisplatin in advanced esophageal cancer. J Clin Oncol 1999; 17:3270.
  3. Coia LR, Myerson RJ, Tepper JE. Late effects of radiation therapy on the gastrointestinal tract. Int J Radiat Oncol Biol Phys 1995; 31:1213.
  4. American Joint Committee on Cancer Staging Manual, 6th, Greene FL, Page DL, Fleming ID, et al (Eds), Springer Verlag, New York 2001. p.91.
  5. Mallery S, Van Dam J. Increased rate of complete EUS staging of patients with esophageal cancer using the nonoptical, wire-guided echoendoscope. Gastrointest Endosc 1999; 50:53.
  6. Wallace MB, Hawes RH, Sahai AV, et al. Dilation of malignant esophageal stenosis to allow EUS guided fine-needle aspiration: safety and effect on patient management. Gastrointest Endosc 2000; 51:309.
  7. Riedel M, Hauck RW, Stein HJ, et al. Preoperative bronchoscopic assessment of airway invasion by esophageal cancer: a prospective study. Chest 1998; 113:687.
  8. Krasna MJ, Reed CE, Nedzwiecki D, et al. CALGB 9380: a prospective trial of the feasibility of thoracoscopy/laparoscopy in staging esophageal cancer. Ann Thorac Surg 2001; 71:1073.
  9. Luketich JD, Schauer P, Landreneau R, et al. Minimally invasive surgical staging is superior to endoscopic ultrasound in detecting lymph node metastases in esophageal cancer. J Thorac Cardiovasc Surg 1997; 114:817.
  10. Luketich JD, Meehan M, Nguyen NT, et al. Minimally invasive surgical staging for esophageal cancer. Surg Endosc 2000; 14:700.
  11. Koike R, Nishimura Y, Nakamatsu K, et al. Concurrent chemoradiotherapy for esophageal cancer with malignant fistula. Int J Radiat Oncol Biol Phys 2008; 70:1418.
  12. Eloubeidi MA, Wallace MB, Hoffman BJ, et al. Predictors of survival for esophageal cancer patients with and without celiac axis lymphadenopathy: impact of staging endosonography. Ann Thorac Surg 2001; 72:212.
  13. Bolton JS, Fuhrman GM, Richardson WS. Esophageal resection for cancer. Surg Clin North Am 1998; 78:773.
  14. Mannell A, Becker PJ, Nissenbaum M. Bypass surgery for unresectable oesophageal cancer: early and late results in 124 cases. Br J Surg 1988; 75:283.
  15. Forshaw MJ, Gossage JA, Chrystal K, et al. Neoadjuvant chemotherapy for locally advanced carcinoma of the lower oesophagus and oesophago-gastric junction. Eur J Surg Oncol 2006; 32:1114.
  16. Bruzzi JF, Swisher SG, Truong MT, et al. Detection of interval distant metastases: clinical utility of integrated CT-PET imaging in patients with esophageal carcinoma after neoadjuvant therapy. Cancer 2007; 109:125.
  17. van Andel JG, Dees J, Dijkhuis CM, et al. Carcinoma of the esophagus: results of treatment. Ann Surg 1979; 190:684.
  18. Petrovich Z, Langholz B, Formenti S, et al. Management of carcinoma of the esophagus: the role of radiotherapy. Am J Clin Oncol 1991; 14:80.
  19. Herskovic A, Martz K, al-Sarraf M, et al. Combined chemotherapy and radiotherapy compared with radiotherapy alone in patients with cancer of the esophagus. N Engl J Med 1992; 326:1593.
  20. al-Sarraf M, Martz K, Herskovic A, et al. Progress report of combined chemoradiotherapy versus radiotherapy alone in patients with esophageal cancer: an intergroup study. J Clin Oncol 1997; 15:277.
  21. Caspers RJ, Welvaart K, Verkes RJ, et al. The effect of radiotherapy on dysphagia and survival in patients with esophageal cancer. Radiother Oncol 1988; 12:15.
  22. Wobbes T, Baron B, Paillot B, et al. Prospective randomised study of split-course radiotherapy versus cisplatin plus split-course radiotherapy in inoperable squamous cell carcinoma of the oesophagus. Eur J Cancer 2001; 37:470.
  23. Wara WM, Mauch PM, Thomas AN, Phillips TL. Palliation for carcinoma of the esophagus. Radiology 1976; 121:717.
  24. O'Rourke IC, Tiver K, Bull C, et al. Swallowing performance after radiation therapy for carcinoma of the esophagus. Cancer 1988; 61:2022.
  25. Muto M, Ohtsu A, Miyamoto S, et al. Concurrent chemoradiotherapy for esophageal carcinoma patients with malignant fistulae. Cancer 1999; 86:1406.
  26. Park JY, Shin JH, Song HY, et al. Airway complications after covered stent placement for malignant esophageal stricture: special reference to radiation therapy. AJR Am J Roentgenol 2012; 198:453.
  27. van den Bongard HJ, Boot H, Baas P, Taal BG. The role of parallel stent insertion in patients with esophagorespiratory fistulas. Gastrointest Endosc 2002; 55:110.
  28. Hürtgen M, Herber SC. Treatment of malignant tracheoesophageal fistula. Thorac Surg Clin 2014; 24:117.
  29. Suntharalingam M, Winter K, Ilson DH, et al. The initial report of RTOG 0436: A phase III trial evaluating the addition of cetuximab to paclitaxel, cisplatin, and radiation for patients with esophageal cancer treated without surgery (abstract). J Clin Oncol 32, 2014 (suppl 3; abstr LBA6). http://meetinglibrary.asco.org/content/123318-143 (Accessed on November 16, 2015).
  30. Minsky BD, Pajak TF, Ginsberg RJ, et al. INT 0123 (Radiation Therapy Oncology Group 94-05) phase III trial of combined-modality therapy for esophageal cancer: high-dose versus standard-dose radiation therapy. J Clin Oncol 2002; 20:1167.
  31. van Hagen P, Hulshof MC, van Lanschot JJ, et al. Preoperative chemoradiotherapy for esophageal or junctional cancer. N Engl J Med 2012; 366:2074.
  32. Penniment MG, Harvey JA, Wong R, et al. A randomized phase III study in advanced esophageal cancer (OC) to compare the quality of life (QoL) and palliation of dysphagia in patients treated with radiotherapy (RT) or chemoradiotherapy (CRT) TROG 03.01 NCIC CTG ES.2 (abstact). J Clin Oncol 32: 5s, 2014 (suppl; abstr 4009). Abstract available online at http://meetinglibrary.asco.org/content/135050-144 (Accessed on June 17, 2014).
  33. Shapiro J, van Lanschot JJ, Hulshof MC, et al. Neoadjuvant chemoradiotherapy plus surgery versus surgery alone for oesophageal or junctional cancer (CROSS): long-term results of a randomised controlled trial. Lancet Oncol 2015; 16:1090.
  34. Coia LR, Soffen EM, Schultheiss TE, et al. Swallowing function in patients with esophageal cancer treated with concurrent radiation and chemotherapy. Cancer 1993; 71:281.
  35. Gill PG, Denham JW, Jamieson GG, et al. Patterns of treatment failure and prognostic factors associated with the treatment of esophageal carcinoma with chemotherapy and radiotherapy either as sole treatment or followed by surgery . J Clin Oncol 1992; 10:1037.
  36. Wong SK, Chiu PW, Leung SF, et al. Concurrent chemoradiotherapy or endoscopic stenting for advanced squamous cell carcinoma of esophagus: a case-control study. Ann Surg Oncol 2008; 15:576.
  37. Ikeda E, Kojima T, Kaneko K, et al. Efficacy of concurrent chemoradiotherapy as a palliative treatment in stage IVB esophageal cancer patients with dysphagia. Jpn J Clin Oncol 2011; 41:964.
  38. Ishida K, Iizuka T, Ando N, Ide H. Phase II study of chemoradiotherapy for advanced squamous cell carcinoma of the thoracic esophagus: nine Japanese institutions trial. Jpn J Clin Oncol 1996; 26:310.
  39. Ohtsu A, Boku N, Muro K, et al. Definitive chemoradiotherapy for T4 and/or M1 lymph node squamous cell carcinoma of the esophagus. J Clin Oncol 1999; 17:2915.
  40. Stahl M, Stuschke M, Lehmann N, et al. Chemoradiation with and without surgery in patients with locally advanced squamous cell carcinoma of the esophagus. J Clin Oncol 2005; 23:2310.
  41. Urba SG, Turrisi AT 3rd. Split-course accelerated radiation therapy combined with carboplatin and 5-fluorouracil for palliation of metastatic or unresectable carcinoma of the esophagus. Cancer 1995; 75:435.
  42. Yin W. Radiotherapy of carcinoma of oesophagus in China. Chin Med J (Engl) 1997; 110:289.
  43. Sur RK, Singh DP, Sharma SC, et al. Radiation therapy of esophageal cancer: role of high dose rate brachytherapy. Int J Radiat Oncol Biol Phys 1992; 22:1043.
  44. Calais G, Dorval E, Louisot P, et al. Radiotherapy with high dose rate brachytherapy boost and concomitant chemotherapy for Stages IIB and III esophageal carcinoma: results of a pilot study. Int J Radiat Oncol Biol Phys 1997; 38:769.
  45. Iwasa M, Ohmori Y, Iwasa Y, et al. Effect of multidisciplinary treatment with high dose rate intraluminal brachytherapy on survival in patients with unresectable esophageal cancer. Dig Surg 1998; 15:227.
  46. Chiarion-Sileni V, Corti L, Ruol A, et al. Phase II trial of docetaxel, cisplatin and fluorouracil followed by carboplatin and radiotherapy in locally advanced oesophageal cancer. Br J Cancer 2007; 96:432.
  47. Ishikawa H, Sakurai H, Tamaki Y, et al. Radiation therapy alone for stage I (UICC T1N0M0) squamous cell carcinoma of the esophagus: indications for surgery or combined chemoradiotherapy. J Gastroenterol Hepatol 2006; 21:1290.
  48. Gaspar LE, Qian C, Kocha WI, et al. A phase I/II study of external beam radiation, brachytherapy and concurrent chemotherapy in localized cancer of the esophagus (RTOG 92-07): preliminary toxicity report. Int J Radiat Oncol Biol Phys 1997; 37:593.
  49. Gaspar LE, Nag S, Herskovic A, et al. American Brachytherapy Society (ABS) consensus guidelines for brachytherapy of esophageal cancer. Clinical Research Committee, American Brachytherapy Society, Philadelphia, PA. Int J Radiat Oncol Biol Phys 1997; 38:127.
  50. Blanke CD, Choy H, Teng M, et al. Concurrent paclitaxel and thoracic irradiation for locally advanced esophageal cancer. Semin Radiat Oncol 1999; 9:43.
  51. Adelstein DJ, Rice TW, Rybicki LA, et al. Does paclitaxel improve the chemoradiotherapy of locoregionally advanced esophageal cancer? A nonrandomized comparison with fluorouracil-based therapy. J Clin Oncol 2000; 18:2032.
  52. Kim DW, Blanke CD, Wu H, et al. Phase II study of preoperative paclitaxel/cisplatin with radiotherapy in locally advanced esophageal cancer. Int J Radiat Oncol Biol Phys 2007; 67:397.
  53. Chiarion-Sileni V, Innocente R, Cavina R, et al. Multi-center phase II trial of chemo-radiotherapy with 5-fluorouracil, leucovorin and oxaliplatin in locally advanced esophageal cancer. Cancer Chemother Pharmacol 2009; 63:1111.
  54. Ruppert BN, Watkins JM, Shirai K, et al. Cisplatin/Irinotecan versus carboplatin/paclitaxel as definitive chemoradiotherapy for locoregionally advanced esophageal cancer. Am J Clin Oncol 2010; 33:346.
  55. Zhao T, Chen H, Zhang T. Docetaxel and cisplatin concurrent with radiotherapy versus 5-fluorouracil and cisplatin concurrent with radiotherapy in treatment for locally advanced oesophageal squamous cell carcinoma: a randomized clinical study. Med Oncol 2012; 29:3017.
  56. Conroy T, Yataghène Y, Etienne PL, et al. Phase II randomised trial of chemoradiotherapy with FOLFOX4 or cisplatin plus fluorouracil in oesophageal cancer. Br J Cancer 2010; 103:1349.
  57. Tomblyn MB, Goldman BH, Thomas CR Jr, et al. Cetuximab plus cisplatin, irinotecan, and thoracic radiotherapy as definitive treatment for locally advanced, unresectable esophageal cancer: a phase-II study of the SWOG (S0414). J Thorac Oncol 2012; 7:906.
  58. Conroy T, Galais MP, Raoul JL, et al. Definitive chemoradiotherapy with FOLFOX versus fluorouracil and cisplatin in patients with oesophageal cancer (PRODIGE5/ACCORD17): final results of a randomised, phase 2/3 trial. Lancet Oncol 2014; 15:305.
  59. Khushalani NI, Leichman CG, Proulx G, et al. Oxaliplatin in combination with protracted-infusion fluorouracil and radiation: report of a clinical trial for patients with esophageal cancer. J Clin Oncol 2002; 20:2844.
  60. Ilson DH, Maughan J, et al. RTOG 0436: A phase III trial evaluating the addition of cetuximab to paclitaxel, cisplatin, and radiation for patients with esophageal cancer treated without surgery (abstract). J Clin Oncol 32: 5s, 2014 (suppl; abstr 4007). Abstract available online at http://meetinglibrary.asco.org/content/130058-144 (Accessed on June 17, 2014).
  61. Ajani JA, Winter K, Komaki R, et al. Phase II randomized trial of two nonoperative regimens of induction chemotherapy followed by chemoradiation in patients with localized carcinoma of the esophagus: RTOG 0113. J Clin Oncol 2008; 26:4551.
  62. Bedenne L, Michel P, Bouché O, et al. Chemoradiation followed by surgery compared with chemoradiation alone in squamous cancer of the esophagus: FFCD 9102. J Clin Oncol 2007; 25:1160.
  63. Morita M, Toh Y, Saeki H, et al. Clinical significance of chemoradiotherapy and surgical resection for cT4 esophageal cancer. Anticancer Res 2012; 32:3275.
  64. Pimiento JM, Weber J, Hoffe SE, et al. Outcomes associated with surgery for T4 esophageal cancer. Ann Surg Oncol 2013; 20:2706.
  65. Markar S, Gronnier C, Duhamel A, et al. Salvage Surgery After Chemoradiotherapy in the Management of Esophageal Cancer: Is It a Viable Therapeutic Option? J Clin Oncol 2015; 33:3866.
  66. Nishimura M, Daiko H, Yoshida J, Nagai K. Salvage esophagectomy following definitive chemoradiotherapy. Gen Thorac Cardiovasc Surg 2007; 55:461.
  67. Swisher SG, Wynn P, Putnam JB, et al. Salvage esophagectomy for recurrent tumors after definitive chemotherapy and radiotherapy. J Thorac Cardiovasc Surg 2002; 123:175.
  68. Borghesi S, Hawkins MA, Tait D. Oesophagectomy after definitive chemoradiation in patients with locally advanced oesophageal cancer. Clin Oncol (R Coll Radiol) 2008; 20:221.
  69. Gardner-Thorpe J, Hardwick RH, Dwerryhouse SJ. Salvage oesophagectomy after local failure of definitive chemoradiotherapy. Br J Surg 2007; 94:1059.
  70. Piessen G, Briez N, Triboulet JP, Mariette C. Patients with locally advanced esophageal carcinoma nonresponder to radiochemotherapy: who will benefit from surgery? Ann Surg Oncol 2007; 14:2036.
  71. D'Journo XB, Michelet P, Dahan L, et al. Indications and outcome of salvage surgery for oesophageal cancer. Eur J Cardiothorac Surg 2008; 33:1117.
  72. Urschel JD, Ashiku S, Thurer R, Sellke FW. Salvage or planned esophagectomy after chemoradiation therapy for locally advanced esophageal cancer--a review. Dis Esophagus 2003; 16:60.
  73. Hofstetter WL, Maru DM, Correa A, et al. Salvage resection for esophageal adenocarcinoma after failed definitive chemoradiation (abstract). Data presented at the 2009 ASCO Gastrointestinal Cancer Symposium, San Francisco, CA, January 16, 2009.
  74. Miyata H, Yamasaki M, Takiguchi S, et al. Salvage esophagectomy after definitive chemoradiotherapy for thoracic esophageal cancer. J Surg Oncol 2009; 100:442.
  75. Watanabe M, Mine S, Nishida K, et al. Salvage Esophagectomy After Definitive Chemoradiotherapy for Patients with Esophageal Squamous Cell Carcinoma: Who Really Benefits from this High-Risk Surgery? Ann Surg Oncol 2015; 22:4438.
  76. Liu SL, Xi M, Yang H, et al. Is There a Correlation Between Clinical Complete Response and Pathological Complete Response After Neoadjuvant Chemoradiotherapy for Esophageal Squamous Cell Cancer? Ann Surg Oncol 2016; 23:273.
  77. Toxopeus EL, Nieboer D, Shapiro J, et al. Nomogram for predicting pathologically complete response after neoadjuvant chemoradiotherapy for oesophageal cancer. Radiother Oncol 2015; 115:392.
  78. Noordman BJ, Shapiro J, Spaander MC, et al. Accuracy of Detecting Residual Disease After Cross Neoadjuvant Chemoradiotherapy for Esophageal Cancer (preSANO Trial): Rationale and Protocol. JMIR Res Protoc 2015; 4:e79.
  79. Sreedharan A, Harris K, Crellin A, et al. Interventions for dysphagia in oesophageal cancer. Cochrane Database Syst Rev 2009; :CD005048.
  80. Steyerberg EW, Homs MY, Stokvis A, et al. Stent placement or brachytherapy for palliation of dysphagia from esophageal cancer: a prognostic model to guide treatment selection. Gastrointest Endosc 2005; 62:333.
  81. Fleischman EH, Kagan AR, Bellotti JE, et al. Effective palliation for inoperable esophageal cancer using intensive intracavitary radiation. J Surg Oncol 1990; 44:234.
  82. Jager JJ, Pannebakker M, Rijken J, et al. Palliation in esophageal cancer with a single session of intraluminal irradiation. Radiother Oncol 1992; 25:134.
  83. Sur RK, Levin CV, Donde B, et al. Prospective randomized trial of HDR brachytherapy as a sole modality in palliation of advanced esophageal carcinoma--an International Atomic Energy Agency study. Int J Radiat Oncol Biol Phys 2002; 53:127.
  84. Homs MY, Steyerberg EW, Eijkenboom WM, et al. Single-dose brachytherapy versus metal stent placement for the palliation of dysphagia from oesophageal cancer: multicentre randomised trial. Lancet 2004; 364:1497.
  85. Bergquist H, Wenger U, Johnsson E, et al. Stent insertion or endoluminal brachytherapy as palliation of patients with advanced cancer of the esophagus and gastroesophageal junction. Results of a randomized, controlled clinical trial. Dis Esophagus 2005; 18:131.
  86. Segalin A, Little AG, Ruol A, et al. Surgical and endoscopic palliation of esophageal carcinoma. Ann Thorac Surg 1989; 48:267.
  87. Orringer MB. Substernal gastric bypass of the excluded esophagus--results of an ill-advised operation. Surgery 1984; 96:467.
  88. Hirai T, Yamashita Y, Mukaida H, et al. Bypass operation for advanced esophageal cancer--an analysis of 93 cases. Jpn J Surg 1989; 19:182.
  89. Mendenhall WM, Sombeck MD, Parsons JT, et al. Management of Cervical Esophageal Carcinoma. Semin Radiat Oncol 1994; 4:179.
  90. Collin CF, Spiro RH. Carcinoma of the cervical esophagus: changing therapeutic trends. Am J Surg 1984; 148:460.
  91. Hoeben A, Polak J, Van De Voorde L, et al. Cervical esophageal cancer: a gap in cancer knowledge. Ann Oncol 2016; 27:1664.
  92. Bidoli P, Bajetta E, Stani SC, et al. Ten-year survival with chemotherapy and radiotherapy in patients with squamous cell carcinoma of the esophagus. Cancer 2002; 94:352.
  93. Wang HW, Chu PY, Kuo KT, et al. A reappraisal of surgical management for squamous cell carcinoma in the pharyngoesophageal junction. J Surg Oncol 2006; 93:468.
  94. Jones AS, Roland NJ, Hamilton J, et al. Malignant tumours of the cervical oesophagus. Clin Otolaryngol Allied Sci 1996; 21:49.
  95. Stuschke M, Stahl M, Wilke H, et al. Induction chemotherapy followed by concurrent chemotherapy and high-dose radiotherapy for locally advanced squamous cell carcinoma of the cervical oesophagus. Oncology 1999; 57:99.
  96. Burmeister BH, Dickie G, Smithers BM, et al. Thirty-four patients with carcinoma of the cervical esophagus treated with chemoradiation therapy. Arch Otolaryngol Head Neck Surg 2000; 126:205.
  97. Huang SH, Lockwood G, Brierley J, et al. Effect of concurrent high-dose cisplatin chemotherapy and conformal radiotherapy on cervical esophageal cancer survival. Int J Radiat Oncol Biol Phys 2008; 71:735.
  98. Tong DK, Law S, Kwong DL, et al. Current management of cervical esophageal cancer. World J Surg 2011; 35:600.
  99. Cao CN, Luo JW, Gao L, et al. Primary radiotherapy compared with primary surgery in cervical esophageal cancer. JAMA Otolaryngol Head Neck Surg 2014; 140:918.
  100. Cao C, Luo J, Gao L, et al. Definitive radiotherapy for cervical esophageal cancer. Head Neck 2015; 37:151.
  101. Zhang P, Xi M, Zhao L, et al. Clinical efficacy and failure pattern in patients with cervical esophageal cancer treated with definitive chemoradiotherapy. Radiother Oncol 2015; 116:257.
Topic Outline