Practice of radiation therapy for squamous cell esophageal cancer in Austria – a survey on behalf of the ÖGRO-GIT

To evaluate the patterns of care for chemoradiation for squamous cell carcinoma (SCC) of the esophagus in Austria. An anonymous questionnaire (57 items) was sent to all 14 public Austrian radiation oncology departments. Results were analyzed descriptively and compared to the latest versions of two major international guidelines. The response rate was 93%. The median number of patients per center per year was 13 (5–30). All centers reported pretreatment multidisciplinary evaluation. Work-up generally included endoscopy and cross-sectional imaging of chest/abdomen (mainly CT). EUS was used by 61% and PET-CT by 54%. Functional lung testing was reported only by 46%. No center reported the prophylactic placement of feeding tubes or stents. All centers employed IMRT in conventional fractionation with (mostly daily) IGRT. Weekly Carboplatin/Paclitaxel was the preferred chemotherapy regimen in both neoadjuvant (85%) and definitive (69%) settings, although only SCC were included. Neoadjuvant treatment was generally preferred for locally advanced stages in suitable patients, except for those with cervical tumor locations. Median doses to the primary tumor were 41.4 Gy (41.4–50.4 Gy) in the neoadjuvant and 57.7 Gy (50.4–66 Gy) in the definitive setting. Target volumes varied considerably (roughly half of the centers preferred involved vs. elective nodal irradiation). Definition of main OARs was uniform, but dose constraints to OAR differed widely. Intensive follow-up was performed in 77% for at least 5 years. The use of advanced staging procedures, prescription of total (boost) doses in the definitive setting, the issue of involved vs. elective nodal irradiation, and dose constraints to OARs were identified as major areas of disagreement between Austrian centers and inconsistencies with major guidelines.