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Purpose/Objective(s): Stage IV ESCC carries a poor prognosis with a median survival of 6-9 months. The standard treatment has traditionally been chemotherapy. Palliative radiation therapy was used for symptom relief. The optimal treatment for stage IV ESCC has not yet been established. The aim of this study was to compare the efficacy and safety of CCRT versus chemotherapy alone in patients with stage IV ESCC. Materials/Methods: Patients with stage IV ESCC were randomly assigned to the CCRT group and the chemotherapy group. Both groups of patients received at least 2 cycles of chemotherapy with cisplatin and docetaxel every 3 weeks. Patients in CCRT group received 50-60 Gy/ 25-30 fractions/ 5-6 weeks of concurrent radiation therapy to the esophageal primary tumor. The primary end point was overall survival (OS). The secondary end points were progression-free survival (PFS), object response rate (ORR) of primary tumor and toxicity. Results: Between August 2013 and October 2015, 60 patients were enrolled and divided into the CCRT group (n Z 30) and the chemotherapy group (n Z 30). The 60 patients were comprised of 48 male and 12 female patients, with a median age of 56 years (range 36-70 years). The baseline clinical characteristics of the 2 groups were similar. Patients in the CCRT group received a mean 54.7 Gy of radiation therapy and a mean 3.6 cycles of chemotherapy, whereas patients in the chemotherapy group received a mean 3.8 cycles. The ORR of the primary tumor was higher in the CCRT group than in the chemotherapy group (83.3% vs. 46.7%, P Z 0.001). At a median follow-up of 18 months, median PFS (9.3 vs. 4.7 months, P Z 0.021) and median OS (18.3 vs. 10.2 months, P Z 0.001) were significantly longer in the CCRT than that in the chemotherapy group. Overall survival rates at 1and 2 years were 73.3% and 43.3% respectively, in the CCRT group, and 46.6%and 26.7% respectively in chemotherapy group (P Z 0.030) Although grade 3 neutropenia was significantly more frequent in the CCRT group than that in the chemotherapy group (33.3% vs. 20.0%, P < 0.05), the rates of other toxicities did not differ. Conclusion: Concurrent chemoradiation therapy was well tolerated and associated with longer PFS and OS than chemotherapy alone in patients with stage IV ESCC. Controlled randomized, multi-center trials are required to determine whether CCRT is a primary treatment option for patients with stage IV ESCC.

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months, respectively. FIGO stage IB1-IVA tumors were balanced across both groups (p Z 0.468). Median total treatment duration for each group of patients treated before and after MRI integration was 56 days and 58 days (p Z 0.613), respectively. After adjustment for prescription dose, total dose to 2cc to OARs was less in the MRI coregistration group (p Z 0.019 for bladder and rectum, each). On MVA, utilization of MRI for target delineation resulted in fewer severe late (CTCAE grade ! 3) toxicities (p Z 0.045, HR 0.21), with no impact on LC (pZ 0.792). Conclusion: We demonstrate a unique work flow for MRI-based target delineation in CT-based brachytherapy planning. This technique, which is applicable to other institutions without in-room MRI availability, is associated with lower dose to OARs and significantly reduced severe toxicity while maintaining a rapid work-flow, similar total treatment duration, and equivalent LC.