Elliott JA, et al. - In 288 locally advanced esophageal cancer, clinical outcome data were combined with systematic evaluation of pulmonary physiology to determine how neoadjuvant chemoradiation (nCRT) influences pulmonary physiology and clinical outcomes. Patients were treated with standard three-dimensional conformal radiation with a lung dose–volume histogram of V20 less than 25 %, and total radiation between 40 and 41.4 Gy between 2010 and 2016. At baseline and 1 month following nCRT, researchers assessed forced expiratory volume in 1 second, forced vital capacity, and diffusion capacity for carbon monoxide. Findings suggest an alteration in pulmonary physiology in correlation to receipt of modern nCRT. In particular, they noted alteration in diffusion capacity, which is related to short- and longer-term clinical outcomes, highlighting a possibly modifiable index of risk.