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Pearson17 has shown that radiation is the best method of treatment for esophageal cancer; even so, only 20% of his patients treated on a radical basis survived five years. His results are even more remarkable when one considers that these patients were surgical rejects; however, their disease was not so advanced as to be suitable for palliative treatment only. Few, if any, comparable results have been achieved by other radiotherapists, and no surgical series comes near to these results.
It is important to ask why Pearson could achieve such outstanding results. A critical review of the experience at Toronto20 suggests the following conclusions:
A Supervoltage is essential. While cobalt 60 is probably adequate, it is certainly the minimal energy level to give. X-rays of 20 to 25 mev are undoubtedly better for two reasons: they deliver better depth dose and consequently spare more lung tissue; they are affected
Rider WD. Innovations in Radiation Therapy. JAMA. 1974;227(2):183-184. doi:10.1001/jama.1974.03230150035010