Intensity modulated radiation therapy in the treatment of esophageal cancer

Chemoradiation plays a core role in the definitive and preoperative management of esophageal cancer. Remarkable advances in technology now allow for the implementation of intensity modulated radiation therapy (IMRT) to minimize normal organ damage and to maximize coverage of tumorous targets. While IMRT is commonly accepted in the treatment of prostate and head and neck cancers, there have been clinical and dosimetric studies supporting the use of IMRT in esophagus cancer. In addition, the IMRT technique was recently enhanced by the availability of volumetric intensity modulated arc therapy (VMAT). VMAT may allow for faster delivery of IMRT with the advantage of normal organ protection compared to the stop-and-shoot IMRT, with faster delivery time and reduced monitor units. This review summarizes the use of chemoradiation in esophageal cancer, discusses current dosimetric data and clinical outcomes with the use of IMRT, and reviews IMRT as part of multi-modality treatment in esophageal cancer.