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There hasn’t been much headway in recent decades for the treatment of locally advanced esophageal cancer. But with the results of RTOG 0436 published this month in JAMA Onc… there still isn’t any. If you can even remember 1991, that’s when RTOG 8501established the current standard of chemo concurrent with radiation. Note: this is the notorious trial where the radiation alone arm had 0%, yes 0%, overall survival at 5 years. Moving on, RTOG 0436 randomized patients to radiation with concurrent cisplatin/paclitaxel (standard of care) +/- cetuximab (an EGFR monoclonal antibody) with the rationale that 50% of esophageal cancers overexpress EGFR. Unfortunately, targeting that pathway did not improve complete response rates (~60%), local failure (~50%), or overall survival (~40%). So for now, we'll keep treating locally advanced esophageal cancer like it’s 1991.