Patterns of Radiotherapy Practice, Dosimetric Exposure, and Treatment Outcomes in Esophageal Cancer:A Retrospective Cohort Study from a Tertiary Care Center

Background Esophageal cancer frequently presents at an advanced stage in low- and middle-income countries, where radiotherapy plays a central role across curative and palliative settings. While survival outcomes are commonly reported, fewer studies describe real-world radiotherapy practice patterns and organ-at-risk dosimetric exposure. Objectives The primary objective was to evaluate patterns of radiotherapy practice and cardiopulmonary dosimetric exposure in patients with esophageal cancer treated at a tertiary care center. Secondary objectives included treatment completion, multimodality integration, and overall survival. Methods This retrospective cohort study included patients with biopsy-proven esophageal cancer treated with radiotherapy between 2018 and 2021. Demographic, tumor-related, treatment, and dosimetric parameters were extracted from institutional records. Overall survival was analyzed using the Kaplan–Meier method. Results Seventy-nine patients received radiotherapy. Squamous cell carcinoma was the predominant histology, and most patients presented with locally advanced disease. Radiotherapy was delivered across neoadjuvant, definitive, adjuvant, and palliative intents using 2D, 3DCRT, and VMAT techniques. Treatment completion was achieved in 88.6% of patients. Mean heart and lung doses were generally within accepted tolerance ranges. Survival analysis was feasible in 61 patients. The median overall survival was 18 months (95% CI: 12.5–23.4). TNM stage grouping and surgical intervention were significantly associated with overall survival. Among surgically treated thoracic esophageal cancers, neoadjuvant radiotherapy was associated with improved overall survival compared to adjuvant radiotherapy. Conclusion In routine clinical practice, radiotherapy for esophageal cancer can be delivered across diverse clinical intents with acceptable cardiopulmonary dosimetric exposure and high treatment completion rates. Overall survival is largely influenced by disease stage and the feasibility of multimodality treatment. Observed survival differences according to treatment sequencing should be interpreted as reflective of patient selection and disease characteristics rather than definitive treatment effects.