***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
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    Input: CONTEXT Carcinoma of the esophagus traditionally has been treated by surgery or radiation therapy ( RT ) , but 5-year overall survival rates have been only 5 % to 10 % . We previously reported results of a study conducted from January 1986 to April 1990 of combined chemotherapy and RT vs RT alone when an interim analysis revealed significant benefit for combined therapy . OBJECTIVE To report the long-term outcomes of a previously reported trial design ed to determine if adding chemotherapy during RT improves the survival rate of patients with esophageal carcinoma . DESIGN R and omized controlled trial conducted 1985 to 1990 with follow-up of at least 5 years , followed by a prospect i ve cohort study conducted between May 1990 and April 1991 . SETTING Multi-institution participation , ranging from tertiary academic referral centers to general community practice s. PATIENTS Patients had squamous cell or adenocarcinoma of the esophagus , T1 - 3 N0 - 1 M0 , adequate renal and bone marrow reserve , and a Karnofsky score of at least 50 . Interventions Combined modality therapy ( n = 134 ) : 50 Gy in 25 fractions over 5 weeks , plus cisplatin intravenously on the first day of weeks 1 , 5 , 8 , and 11 , and fluorouracil , 1 g/m2 per day by continuous infusion on the first 4 days of weeks 1 , 5 , 8 , and 11 . In the r and omized study , combined therapy was compared with RT only ( n = 62 ) : 64 Gy in 32 fractions over 6.4 weeks . MAIN OUTCOME MEASURES Overall survival , patterns of failure , and toxic effects . RESULTS Combined therapy significantly increased overall survival compared with RT alone . In the r and omized part of the trial , at 5 years of follow-up the overall survival for combined therapy was 26 % ( 95 % confidence interval [ CI ] , 15%-37 % ) compared with 0 % following RT . In the succeeding nonr and omized part , combined therapy produced a 5-year overall survival of 14 % ( 95 % CI , 6%-23 % ) . Persistence of disease ( despite therapy ) was the most common mode of treatment failure ; however , it was less common in the groups receiving combined therapy ( 34/130 [ 26 % ] ) than in the group treated with RT only ( 23/62 [ 37 % ] ) . Severe acute toxic effects also were greater in the combined therapy groups . There were no significant differences in severe late toxic effects between the groups . However , chemotherapy could be administered as planned in only 89 ( 68 % ) of 130 patients ( 10 % had life-threatening toxic effects with combined therapy vs 2 % in the RT only group ) . CONCLUSION Combined therapy increases the survival of patients who have squamous cell or adenocarcinoma of the esophagus , T1 - 3 N0 - 1 M0 , compared with RT alone PURPOSE To compare the local/regional control , survival , and toxicity of combined-modality therapy using high-dose ( 64.8 Gy ) versus st and ard-dose ( 50.4 Gy ) radiation therapy for the treatment of patients with esophageal cancer . PATIENTS AND METHODS A total of 236 patients with clinical stage T1 to T4 , N0/1 , M0 squamous cell carcinoma or adenocarcinoma selected for a nonsurgical approach , after stratification by weight loss , primary tumor size , and histology , were r and omized to receive combined-modality therapy consisting of four monthly cycles of fluorouracil ( 5-FU ) ( 1,000 mg/m(2)/24 hours for 4 days ) and cisplatin ( 75 mg/m(2 ) bolus day 1 ) with concurrent 64.8 Gy versus the same chemotherapy schedule but with concurrent 50.4 Gy . The trial was stopped after an interim analysis . The median follow-up was 16.4 months for all patients and 29.5 months for patients still alive . RESULTS For the 218 eligible patients , there was no significant difference in median survival ( 13.0 v 18.1 months ) , 2-year survival ( 31 % v 40 % ) , or local/regional failure and local/regional persistence of disease ( 56 % v 52 % ) between the high-dose and st and ard-dose arms . Although 11 treatment-related deaths occurred in the high-dose arm compared with two in the st and ard-dose arm , seven of the 11 deaths occurred in patients who had received 50.4 Gy or less . CONCLUSION The higher radiation dose did not increase survival or local/regional control . Although there was a higher treatment-related mortality rate in the patients assigned to the high-dose radiation arm , it did not seem to be related to the higher radiation dose . The st and ard radiation dose for patients treated with concurrent 5-FU and cisplatin chemotherapy is 50.4 Gy Background This retrospective study on early and locally advanced esophageal cancer was conducted to evaluate locoregional failure and its impact on survival by comparing involved field radiotherapy ( IFRT ) with elective nodal irradiation ( ENI ) in combination with concurrent chemotherapy . Methods We assessed all patients with esophageal cancer of stages I-IV treated with definitive radiotherapy from June 2000 to March 2014 . Between 2000 and 2011 , ENI was used for all cases excluding high age cases . After Feb 2011 , a prospect i ve study about IFRT was started , and therefore IFRT was used since then for all cases . Concurrent chemotherapy regimen was nedaplatin ( 80 mg/m2 at D1 and D29 ) and 5-fluorouracil ( 800 mg/m2 at D1 - 4 and D29 - 32 ) . Results Of the 239 consecutive patients assessed ( 120 ENI vs. 119 IFRT ) , 59 patients ( 24.7 % ) had stage IV disease and all patients received at least one cycle of chemotherapy . The median follow-up time for survivors was 34.0 months . There were differences in 3-year local control ( 44.8 % vs. 55.5 % , p = 0.039 ) , distant control ( 53.8 % vs. 69.9 % , p = 0.021 ) and overall survival ( 34.8 % vs. 51.6 % , p = 0.087 ) rates between ENI vs. IFRT , respectively . Patients treated with IFRT ( 8 % ) demonstrated a significantly lower risk ( p = 0.047 ) of high grade late toxicities than with ENI ( 16 % ) . IFRT did not increase the risk of initially uninvolved or isolated nodal failures ( 27.5 % in ENI and 13.4 % in IFRT ) . Conclusions Nodal failure rates in clinical ly uninvolved nodal stations were not increased with IFRT when compared to ENI . IFRT also result ed in significantly decreased esophageal toxicity , suggesting that IFRT may allow for integration of concurrent systemic chemotherapy in a greater proportion of patients . Both tendencies of improved loco-regional progression-free survival and a significant increased overall survival rate favored the IFRT arm over the ENI arm in this study Background : The aim of this study was to investigate the feasibility of involved-field irradiation ( IFI ) for the treatment of cervical and upper-thoracic esophageal cancer with concurrent chemoradiation . Patients and Methods : 102 eligible patients with cervical or upper-thoracic esophageal cancer were treated with concurrent chemoradiation and r and omized to either an IFI or elective nodal irradiation ( ENI ) group . Results : Adverse events included infection ( 27.4 vs. 64.7 % ) and nausea ( 25.4 vs. 54.9 % ) , with a statistically significant difference between the IFI and the ENI group ( p = 0.008 and 0.028 , respectively ) . No difference was seen for late radiation reaction . The cumulative incidence of local/regional failure ( 13.7 vs. 17.6 % ) and regional lymph failure ( 7.8 vs. 9.8 % ) showed no statistically significant difference between the IFI versus the ENI group ( p = 0.837 and 0.837 , respectively ) . A nodal out-field relapse rate of only 2 % was seen in the IFI group . 3-year survival rates for the ENI and IFI group were 41.3 and 32.0 % , respectively ( p = 0.58 ) , and 3-year local control rates were 85.7 and 80.1 % , respectively ( p = 0.34 ) . Conclusion : IFI was acceptable for cervical and upper-thoracic esophageal cancer with a decrease in acute toxicities and no increase in lymph node failure PURPOSE To evaluate the local control , survival , and toxicity associated with three-dimensional conformal radiotherapy ( 3D-CRT ) for squamous cell carcinoma ( SCC ) of the esophagus , to determine the appropriate target volumes , and to determine whether elective nodal irradiation is necessary in these patients . METHODS AND MATERIAL S A prospect i ve study of 3D-CRT was undertaken in patients with esophageal SCC without distant metastases . Patients received 68.4 Gy in 41 fractions over 44 days using late-course accelerated hyperfractionated 3D-CRT . Only the primary tumor and positive lymph nodes were irradiated . Isolated out-of-field regional nodal recurrence was defined as a recurrence in an initially uninvolved regional lymph node . RESULTS All 53 patients who made up the study population  tolerated the irradiation well . No acute or late Grade 4 or 5 toxicity was observed . The median survival time was 30 months ( 95 % confidence interval , 17.7 - 41.8 ) . The overall survival rate at 1 , 2 , and 3 years was 77 % , 56 % , and 41 % , respectively . The local control rate at 1 , 2 , and 3 years was 83 % , 74 % , and 62 % , respectively . Thirty-nine of the 53 patients ( 74 % ) showed treatment failure . Seventeen of the 39 ( 44 % ) developed an in-field recurrence , 18 ( 46 % ) distant metastasis with or without regional failure , and 3 ( 8 % ) an isolated out-of-field nodal recurrence only . One patient died of disease in an unknown location . CONCLUSIONS In patients treated with 3D-CRT for esophageal SCC , the omission of elective nodal irradiation was not associated with a significant amount of failure in lymph node regions not included in the planning target volume . Local failure and distant metastases remained the predominant problems Background and purpose The purpose of this study was to evaluate the radiotherapy ( RT ) quality assurance ( QA ) for JCOG 0303 . Methods and material sJCOG 0303 was a multi-center phase II/III trial that compared two types of chemotherapy administered concomitantly with RT  for locally advanced esophageal cancer . RT requirements included a total dose of 60 Gy in 30 fractions and CTV with a 2-cm margin cranio-caudally to the primary tumor . The QA assessment was given as per protocol ( PP ) , deviation acceptable ( DA ) , violation unacceptable ( VU ) , and incomplete/not evaluable following predefined criteria for quality parameters . Results A total of 142 cases were accrued . After excluding 36 incomplete/not evaluable , 106 ( 75 % ) were fully evaluable for RT quality review . Of these 106 , there were 4 VU ( 4 % ) and overall RT compliance ( PP + DA ) was 96 % . Comparing the incidence of VU based on the numbers enrolled by institution , the highest quarter of enrollment ( ≥7 cases ) had no VU , while all VU ( 4 ; 11 % ) were from institutions enrolling < 7 patients . Conclusions The results of the RTQA assessment for JCOG 0303 were sufficient to provide reliable results . Additional improvements will be needed for institutions with low accrual rates 
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Meanwhile , the incidences of esophageal and lung toxicities were significantly decreased in the IFI arm .
These results suggest that IFI is a feasible treatment option for locally advanced esophageal cancer , especially to minimize irradiation-related toxicity