title: A randomized study to compare sequential chemoradiotherapy with concurrent chemoradiotherapy for unresectable locally advanced esophageal cancer.
abstract: BACKGROUND
  Chemotherapy combined with radiotherapy can improve outcome in locally advanced esophageal cancer.
  
  
  OBJECTIVE
  This study aimed to compare efficacy and toxicity between concurrent chemoradiotherapy (CCRT) and sequential chemoradiotherapy (SCRT) in unresectable, locally advanced, esophageal squamous cell carcinoma (ESSC).
  
  
  METHODS
  Forty-one patients with unresectable, locally advanced ESCC were randomized into two arms. In the CCRT arm (Arm A), 17 patients received 50.4 Gy at 1.8 Gy per fraction over 5.6 weeks along with concurrent cisplatin (75 mg m(-2) intravenously on day 1 and 5-fluorouracil (1000 mg m(-2) continuous intravenous infusion on days 1-4 starting on the first day of irradiation and given after 28 days. In the SCRT arm (Arm B), 20 patients received two cycles of chemotherapy, using the same schedule, followed by radiotherapy fractionated in a similar manner. The endpoints were tumor response, acute and late toxicities, and disease-free survival.
  
  
  RESULTS
  With a median follow up of 12.5 months, the complete response rate was 82.4% in Arm A and 35% in Arm B (P = 0.003). Statistically significant differences in frequencies of acute skin toxicity (P = 0.016), gastrointestinal toxicity (P = 0.005) and late radiation pneumonitis (P = 0.002) were found, with greater in the CCRT arm. A modest but non-significant difference was observed in median time to recurrence among complete responders in the two arms (Arm A 13 months and Arm B 15.5 months, P = 0.167) and there was also no significant difference between the Kaplan Meier survival plots (P = 0.641) of disease-free survival.
  
  
  CONCLUSIONS
  Compared to sequential chemoradiotherapy, concurrent chemoradiotherapy can significantly improve local control rate but with greater risk of adverse reactions.
authors.affiliation: Department of Radiotherapy, IPGMER & SSKM Hospital, Kolkata, West Bengal, India.
authors.forename: Arunima
authors.initials: A
authors.lastname: Gupta
authors.affiliation: Department of Radiotherapy, IPGMER & SSKM Hospital, Kolkata, West Bengal, India.
authors.forename: Somnath
authors.initials: S
authors.lastname: Roy
authors.affiliation: Department of Radiotherapy, IPGMER & SSKM Hospital, Kolkata, West Bengal, India.
authors.forename: Anup
authors.initials: A
authors.lastname: Majumdar
authors.affiliation: Department of Radiotherapy, IPGMER & SSKM Hospital, Kolkata, West Bengal, India.
authors.forename: Avijit
authors.initials: A
authors.lastname: Hazra
authors.affiliation: Department of Radiotherapy, IPGMER & SSKM Hospital, Kolkata, West Bengal, India.
authors.forename: Chandrani
authors.initials: C
authors.lastname: Mallik
keywords: Concurrent chemoradiation; esophageal cancer; sequential chemoradiotherapy