Concurrent Chemotherapy and Radiotherapy: Concurrent chemotherapy with radiotherapy has been studied in the locally advanced setting through randomized trials that have attempted to capitalize on the radiosensitizing properties of chemotherapy. An EORTC three-arm trial published in 1992 compared radiotherapy (split course) concurrent with daily or weekly concurrent cisplatin to radiotherapy alone. There were improved 2-year and 3-year survivals for daily chemotherapy concurrent with radiotherapy compared with radiotherapy alone (26% and 16% vs 13% and 2%, respectively). There was no significant advantage for the weekly chemo-therapy-plus-radiotherapy arm, with an intermediate survival compared to the other arms.
Whether concurrent chemotherapy plus radiotherapy yields an improvement in survival over sequential chemotherapy plus radiotherapy has been addressed by a few trials, including a large Japanese randomized trial of 320 patients that compared chemotherapy (mitomycin, vindesine, and cisplatin for two cycles) concurrent with split-course daily radiotherapy to 56 Gy compared to chemotherapy followed by continuous daily radiotherapy to 56 Gy. canadian health & care mall
Esophagitis rates were low with concurrent therapy. At 5-year median follow-up, 2-year and 5-year survival was improved for concurrent chemotherapy over sequential chemotherapy with radiotherapy (34.6% and 15.8% vs 27.4% and 8.8%, respectively). Myelosuppression was greater among patients in the concurrent arm, but the mortality rate was low (< 1%) and not significantly different in both groups. Further evaluation through randomized trials addressing this issue are required, with an emphasis on the toxicity profiles of concurrent strategies vs sequential strategies.