Objective: Chemotherapy (CT) is the standard treatment for patients with metastatic esophageal cancer. Primary tumor progression is one
of the important reasons for morbidity and mortality. Several studies have shown that aggressive treatment of primary tumors in metastatic
patients may contribute to survival. In this study, patients with metastatic esophageal cancer and who received radiotherapy (RT) to the
esophagus were evaluated.

Methods: Patients with metastatic esophageal cancer treated with esophageal RT were retrospectively evaluated. ECOG 3-4 patients were not
included. Analyzes were performed with SPSS 22.0 (SPSS Inc., IBM Corp., Armonk, NY). Kaplan-Meier, Log-rank, and Cox-regression tests were
used for the analysis.

Results: Forty-seven patients between 2009 and 2016 were evaluated. The median age was 61 (44-85); 60% of the patients were female.
Eighty-nine percent of the histological subtype was squamous cell carcinoma. The mean RT dose was 45 Gy (20-68 Gy). Thirty percent of the
patients had concurrent CT. The median overall survival (OS) was 14 months. 45 Gy and higher RT doses and concurrent CT were associated
with better OS in univariate analysis (p=0.009, p=0.03). The median OS was nine months in patients receiving <45 Gy, and 20 months in
patients who received RT ≥45 Gy; 24 months in patients who received concurrent CT, and 13 months in patients who did not. There was no
significant prognostic factor in multivariate analysis.

Conclusion: Forty-five Gy and higher dose RT with concurrent CT after standard treatment may contribute to survival in metastatic esophageal
cancer patients with good performance scores.