Cushman TR, et al. - Investigators broke 519 individuals into three primary cohorts (those receiving chemotherapy (CT) with/without subtherapeutic radiotherapy (RT), definitive chemoradiotherapy (CRT), or CT with/without RT followed by definitive surgery) to describe national practice patterns and consequences for the cT4b esophageal cancer (EC) population. They observed 195 underwent CT, 291 underwent definitive CRT, and 33 underwent surgical-based treatment. Candidates residing in rural areas living farther from the treating facility and those with N1 status were more likely to have surgery. Median overall survival (OS) in cases of CT with/without RT, CRT, and CT with/without RT followed by definitive surgery were 6.0, 12.7, and 43.9 months, respectively. They found an association between poorer OS and nonsurgical therapy while adding definitive RT was associated with higher OS vs CT alone.