Work

Real-world trends in radiotherapy modalities for esophageal cancer: analysis of a nationwide claims database in Japan

Year: 2026

Type: article

Abstract: BACKGROUND: Recently, the application of Intensity-Modulated Radiotherapy (IMRT) and changes in fractionation schedules have been increasingly introduced in radiotherapy practice for esophageal cancer. However, the extent of their adoption and prevalence in real-world clinical practice remains unclear. This study aimed to describe nationwide trends in radiotherapy for esophageal cancer using a large-scale health insurance claims database. METHODS: Using the DeSC database, we identified patients newly diagnosed with esophageal cancer between April 2017 and March 2023. Patients treated with definitive radiotherapy (defined as 25-35 treatment days in patients without distant metastasis) were selected. We analyzed temporal trends in radiotherapy, regional differences, and the incidence of radiation pneumonitis. RESULTS: Among patients with an identified initial treatment, the proportion of radiotherapy declined from 28.6% in 2017 to 19.6% in 2022. A total of 1,324 patients were included in the definitive radiotherapy group. The use of IMRT increased substantially from 10.7% in 2017 to 44.9% in 2022. Regarding fractionation, treatments of 25-28 days increased from 25.0% to 35.9%, while those of 31-35 days decreased. While CDDP/5-FU remained the dominant concurrent chemotherapy, its proportion declined as other platinum-based regimens increased. Urban facilities showed significantly higher implementation of Image-Guided Radiotherapy (IGRT) compared with rural facilities. The cumulative incidence of hospitalization for radiation pneumonitis at 12 months was 1.5%. The cumulative incidence was not significantly altered by IMRT use (sHR: 0.32, p = 0.13), whereas it was lower in patients receiving IGRT (sHR: 0.39, p = 0.04). CONCLUSIONS: This nationwide study demonstrated increased use of advanced techniques including IMRT and IGRT, and shorter fractionation schedules in radiotherapy for esophageal cancer in Japanese clinical practice.

Source: Esophagus

DOI: 10.1007/s10388-026-01248-6