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CC BY-NC-ND 4.0 · Indian J Med Paediatr Oncol 2014; 35(01): 54-59
DOI: 10.4103/0971-5851.133722
ORIGINAL ARTICLE

A randomized study to compare sequential chemoradiotherapy with concurrent chemoradiotherapy for unresectable locally advanced esophageal cancer

Arunima Gupta
Department of Radiotherapy, IPGMER & SSKM Hospital, Kolkata, West Bengal, India
,
Somnath Roy
Department of Radiotherapy, IPGMER & SSKM Hospital, Kolkata, West Bengal, India
,
Anup Majumdar
Department of Radiotherapy, IPGMER & SSKM Hospital, Kolkata, West Bengal, India
,
Avijit Hazra
Department of Radiotherapy, IPGMER & SSKM Hospital, Kolkata, West Bengal, India
,
Chandrani Mallik
Department of Radiotherapy, IPGMER & SSKM Hospital, Kolkata, West Bengal, India
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Abstract

Background: Chemotherapy combined with radiotherapy can improve outcome in locally advanced esophageal cancer. Aim: 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). Materials and 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.

Keywords

Concurrent chemoradiation - esophageal cancer - sequential chemoradiotherapy


Publication History

Article published online:
19 July 2021

© 2014. Indian Society of Medical and Paediatric Oncology. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial-License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/.)

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