Radiation dose in neoadjuvant chemoradiation therapy for esophageal cancer: patterns of care and outcomes from the National Cancer Data Base

Esophageal cancer (EC) is a major cause of both cancer-related mortality worldwide, with an estimated 400,000 annual deaths attributable to this disease (1). The current standard of care is neoadjuvant chemoradiation (CRT) followed by definitive surgery, based on the landmark publication of the CROSS trial in 2012, which has provided the most definitive evidence for trimodality therapy in locally advanced EC (2,3). The CROSS protocol consisted of preoperative carboplatin/paclitaxel administered concurrently with radiation therapy (RT) to a dose of 41.4 Gy. This dose was somewhat unconventional in light of many prospective trials that utilized 45 Gy (4-6). However, prospective trials have, in fact, utilized total doses as low as 35–37 Gy as part of preoperative multimodality management, with satisfactory results (7,8)