Concurrent versus sequential chemoradiation therapy

In the first trial, the combination of mitomycin C, vindesine, and cisplatin were given concurrently with split-course daily radiation therapy to 56 Gy compared with chemotherapy followed by continuous daily radiation therapy to 56 Gy.[37]

In the first trial, the combination of mitomycin C, vindesine, and cisplatin were given concurrently with split-course daily radiation therapy to 56 Gy compared with chemotherapy followed by continuous daily radiation therapy to 56 Gy.[37]

Five-year OS rates favored concurrent therapy (27% vs. 9%).

In the first trial, the combination of mitomycin C, vindesine, and cisplatin were given concurrently with split-course daily radiation therapy to 56 Gy compared with chemotherapy followed by continuous daily radiation therapy to 56 Gy.[37]

Myelosuppression was greater among patients in the concurrent arm, but treatment-related mortality was less than 1% in both arms.[37]

In the second trial, 610 patients were randomly assigned to sequential chemotherapy with cisplatin and vinblastine followed by 63 Gy of radiation therapy, concurrent chemoradiation therapy using the same regimen, or concurrent chemotherapy with cisplatin and etoposide with twice-daily radiation therapy.[39]

In the second trial, 610 patients were randomly assigned to sequential chemotherapy with cisplatin and vinblastine followed by 63 Gy of radiation therapy, concurrent chemoradiation therapy using the same regimen, or concurrent chemotherapy with cisplatin and etoposide with twice-daily radiation therapy.[39]

Median and 5-year survival were superior in the concurrent chemotherapy with daily radiation therapy arm (17 months vs. 14.6 months and 16% vs. 10% for sequential regimen; P = .046).[39]

Two smaller studies also reported OS results that favored concurrent over sequential chemotherapy and radiation, although the results did not reach statistical significance.[38,40][Level of evidence A1]

A meta-analysis of three trials evaluated concurrent versus sequential treatment (711 patients).[36]

A meta-analysis of three trials evaluated concurrent versus sequential treatment (711 patients).[36]

The analysis indicated a significant benefit of concurrent over sequential treatment (RR, 0.86; 95% CI, 0.78–0.95; P = .003). All studies used cisplatin-based regimens and once-daily radiation therapy.[36]

A meta-analysis of three trials evaluated concurrent versus sequential treatment (711 patients).[36]

More deaths (3% OS rate) were reported in the concurrent arm, but this did not reach statistical significance (RR, 1.60; 0.75–3.44; P = .2).

A meta-analysis of three trials evaluated concurrent versus sequential treatment (711 patients).[36]

There was more acute esophagitis (grade 3 or worse) with concurrent treatment (range, 17%–26%) compared with sequential treatment (range, 0%–4%; RR, 6.77; P = .001). Overall, the incidence of neutropenia (grade 3 or worse) was similar in both arms.