David Ilson, MD, of Memorial Sloan Kettering Cancer Center in New York, criticized the trial presented by Dr. Penniment at the 2015 Gastrointestinal Cancers Symposium for lacking a chemotherapy-alone arm. “Chemotherapy alone, in phase III trials, has achieved dysphagia relief in 70% of patients,” he said. “To me, it would be a logical consideration to include a chemotherapy-alone arm in the trial.”

He acknowledged that for palliation, radiotherapy alone “is reasonable,” but “to claim that 3 weeks of radiotherapy is keeping patients alive for 1 or 2 years is preposterous. I am surprised that patients would live with radiation alone for 9 to 10 months. This is an aggressive cancer, and on supportive care alone, patients die within a few months.”

Outside of strict palliation, according to Dr. Ilson, “It’s not clinically appropriate to give radiotherapy alone and follow the patients…. I disagree completely that this is a first choice.”

Dr. Ilson said he initiates chemotherapy in patients with metastatic esophageal cancer. “If they respond, and their dysphagia gets better, you are also treating them for metastatic disease. Often, I will put a stent in later. If the tumor overgrows the stent, I will give radiation.” ■

Disclosure: Dr. Ilson reported no potential conflicts of interest.