For a study, researchers evaluated the efficacy and safety of 60 Gy and 50 Gy doses delivered with modern radiotherapy technology for definitive concurrent chemoradiotherapy (CCRT) in patients with inoperable esophageal squamous cell carcinoma (ESCC) in this multicenter phase 3 trial. Patients with pathologically confirmed stage IIA‒IVA ESCC were randomly assigned 1:1 to receive 60 Gy or 50 Gy to the tumor and regional lymph nodes. Concurrent weekly chemotherapy (docetaxel 25 mg/m2; cisplatin 25 mg/m2) was given, as well as 2 cycles of consolidation chemotherapy (docetaxel 70 mg/m2; cisplatin 25 mg/m2 days 1‒3). A total of 319 patients were studied for survival, with a 34.0-month median follow-up. The 1- and 3-year locoregional progression-free survival (PFS) rates for the 60 Gy group were 75.6% and 49.5%, respectively, compared to 72.1% and 48.4% for the 50 Gy group [HR, 1.00; 95% CI, 0.751.35; P=0.98]. Overall survival rates were 83.7% and 53.1% versus 84.8% and 52.7% (HR, 0.99; 95% CI, 0.731.35; P=0.96), whereas PFS rates were 71.2% and 46.4% versus 65.2% and 46.1% (HR, 0.97; 95% CI, 0.731.30; P=0.86). The incidence of grade 3+ radiotherapy pneumonitis was higher (nominal P=0.03) in the 60 Gy group than in the 50 Gy group. Compared to the 50 Gy arm, the 60 Gy arm had similar survival endpoints but a higher rate of severe pneumonitis. In CCRT for ESCC, a dose of fifty Gy should be considered.
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