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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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>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\u201335 treatment days in patients without distant metastasis) were selected. We analyzed temporal trends in radiotherapy, regional differences, and the incidence of radiation pneumonitis.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      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\u201328 days increased from 25.0% to 35.9%, while those of 31\u201335 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,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.13), whereas it was lower in patients receiving IGRT (sHR: 0.39,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.04).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>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.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1007\/s10388-026-01248-6","type":"journal-article","created":{"date-parts":[[2026,8,31]],"date-time":"2026-08-31T14:31:12Z","timestamp":1788186672000},"page":"743-754","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Real-world trends in radiotherapy modalities for esophageal cancer: analysis of a nationwide claims database in Japan"],"prefix":"10.1007","volume":"23","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-7354-4063","authenticated-orcid":false,"given":"Kazuya","family":"Takeda","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shinsaku","family":"Okuda","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rei","family":"Umezawa","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Takaya","family":"Yamamoto","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Noriyoshi","family":"Takahashi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hiroshi","family":"Onishi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Keiichi","family":"Jingu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,8,31]]},"reference":[{"key":"1248_CR1","doi-asserted-by":"publisher","first-page":"1593","DOI":"10.1056\/nejm199206113262403","volume":"326","author":"A Herskovic","year":"1992","unstructured":"Herskovic A, Martz K, Al-Sarraf M, Leichman L, Brindle J, Vaitkevicius V, et al. 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