Chemoradiotherapy with extended nodal irradiation and/or erlotinib in locally advanced oesophageal squamous cell cancer: long-term update of a randomised phase 3 trial.

BACKGROUND: To report the long-term outcomes of a phase III trial designed to test two hypotheses: (1) elective nodal irradiation (ENI) is superior to conventional field irradiation (CFI), and (2) chemoradiotherapy plus erlotinib is superior to chemoradiotherapy in locally advanced oesophageal squamous cell cancer (ESCC). METHODS: Patients with locally advanced ESCC were randomly assigned (1:1:1:1 ratio) to one of the four groups: A: radiotherapy adoption of ENI with two cycles of concurrent TP chemotherapy (paclitaxel and cisplatin) plus erlotinib; B: radiotherapy adoption of ENI with two cycles of concurrent TP; C: radiotherapy adoption of CFI with two cycles of concurrent TP plus erlotinib and D: radiotherapy adoption of CFI with two cycles of concurrent TP. A total of 60 Gy of radiation doses was delivered over 30 fractions. We explored the impact of epidermal growth factor receptor (EGFR) expression on the efficacy of erlotinib plus chemoradiotherapy. RESULTS: A total of 352 patients (88 assigned to each treatment group) were enrolled. The 5-year survival rates were 44.9%, 34.8%, 33.8% and 19.6% in groups A, B, C and D, respectively (P = 0.013). ENI significantly improved OS compared with standard CFI (median, 38.5 vs 22.6 months; HR, 0.74; P = 0.018). The addition of erlotinib significantly improved OS (median, 39.4 vs 27.4 months; HR, 0.75; P = 0.025). Patients with overexpressing EGFR treated with erlotinib had a better OS and PFS than those without erlotinib. CONCLUSIONS: Concurrent chemoradiotherapy with ENI and/or erlotinib improved long-term survival in locally advanced ESCC. CLINICAL TRIAL REGISTRATION: Trial registration: NCT00686114.

New Insights into Flexible Transparent Conductive Silver Nanowires Films.

Flexible transparent conductive films (FTCFs) composed of silver nanowires (AgNWs) have become an important research direction because of their potential in flexible electronic devices. The optoelectronic properties of FTCFs composed of AgNWs of different lengths were evaluated in this study. AgNWs, with an average diameter of about 25 nm and length of 15.49-3.92 µm were obtained by a sonication-induced scission process. AgNW-FTCFs were prepared on polyethylene terephthalate substrates using a Meyer bar and then dried in the ambient environment. The sheet resistance, non-uniformity factor of the sheet resistance, the root mean square roughness, and haze of the FTCFs increased as the length of AgNWs decreased. The transmittance of the films increased slightly as the length of AgNWs increased. AgNWs with a length of 15.49 µm provided an AgNW-FTCF with excellent properties including haze of 0.95%, transmittance of 93.42%, and sheet resistance of 80.15 Ω∙sq-1, without any additional post-treatment of the film. This work investigating the dependence of the optoelectronic properties of AgNW-FTCFs on AgNW length provides design guidelines for development of AgNW-FTCFs.

Reactive Conductive Ink Capable of In Situ and Rapid Synthesis of Conductive Patterns Suitable for Inkjet Printing.

We report a fabrication method of the conductive pattern based on in situ reactive silver precursor inks by inkjet printing. The reactive silver precursor inks were prepared with ethylene glycol and deionized water mixture as the solvent, and silver nitrate as silver source. Sodium borohydride solution as the reducing agent was first coated on photographic paper by screen printing process, and then dried at 50 °C for 4 h. Furthermore, the reactive silver precursor inks were printed on a photographic paper coated with sodium borohydride using inkjet printing to form silver nanoparticles in situ due to redox reaction, and thus a conductive pattern was obtained. The effects of the reactive silver precursor ink concentration and printing layer number and treatment temperature on the electrical properties and microstructures of the printed patterns were investigated systematically. The size range of in situ-formed silver nanoparticles was 50-90 nm. When the reactive silver precursor ink concentration was 0.13 g/mL, the five-layer printed pattern exhibited a sheet resistance of 4.6 Ω/γ after drying at room temperature for 2 h; furthermore, the sheet resistance of the printed pattern decreased to 1.4 Ω/γ after drying at 130 °C for 2 h. In addition, the display function circuit was printed on the photographic paper to realize the display of the numbers 0-99. It provides new research ideas for the development of environmentally friendly and low-cost flexible paper-based circuits.

Concurrent chemoradiotherapy with elective lymph node irradiation for esophageal cancer: a systemic review and pooled analysis of the literature.

Concurrent chemoradiotherapy (CCRT) has been accepted as the standard non-surgical treatment for esophageal cancer. However, no consistent conclusions have been reached whether elective lymph node irradiation (ENI) should be delivered. Therefore, we performed a systematic review and pooled analysis to evaluate the value of CCRT with ENI. A literature search based on PubMed, Embase and Google Scholar was carried out and all of the studies were evaluated carefully regarding with survival outcomes, response rates, patterns of failure rates and acute/late toxicities. Twenty-two studies were identified based on the criteria: median overall survival time was 21.0 months; pooled response rates were 56.8% (CR) and 85.8% (CR+PR), respectively; residual disease rate, local-regional recurrence rate, distant failure rate and both (local-regional recurrence plus distant failure) rate was 28%, 21%, 11%, and 7%, respectively; hematologic toxicities were the most sever acute toxicities and esophagus-related toxicity was the most common radiation-related toxicity both in acute (15.7%) and late (6.2%) phase. In conclusion, ENI is feasible with acceptable toxicities in esophageal carcinoma and the efficacy should be verified in randomized trials.

Curcumol ß-cyclodextrin inclusion complex enhances radiosensitivity of esophageal cancer under hypoxic and normoxic condition.

PURPOSE: Radiotherapy is an indispensable treatment for esophageal cancer (EC), but radioresistance is not uncommon. Curcumol, as an active extract from traditional Chinese medicines, has been reported to have antitumor activity in various types of human tumor cells. However, its reversal of radioresistance has been rarely reported. MATERIALS AND METHODS: In the present study, curcumol was prepared as an inclusion complex with ß-cyclodextrin. EC cell lines were treated with radiation and curcumol ß-cyclodextrin inclusion complex (CßC), and the effect of radiosensitization of CßC was investigated in vitro and in vivo. The in vitro experiments included cell proliferation assay, clonogenic survival assay, apoptosis assay, cell cycle assay, and western blot assay. RESULTS: The in vitro data revealed that CßC and irradiation synergistically inhibited the proliferation, reduced the colony formation, promoted the apoptosis, increased the G2/M phase, inhibited DNA damage repair, and reversed the hypoxia-mediated radioresistance of EC cells to a greater extent than did CßC alone or irradiation alone. The sensitization enhancement ratios (SERs) were 1.39 for TE-1 and 1.48 for ECA109 under hypoxia. The SERs were 1.25 for TE-1 and 1.32 for ECA109 under normoxia. The in vivo data demonstrated that the combination of CßC and irradiation could inhibit tumor growth to the greatest extent compared with either monotherapy alone. The enhancement factor was 2.45. CONCLUSION: This study demonstrated that CßC could enhance radiosensitivity of EC cells under hypoxic and normoxic condition. Thus, CßC can be used as an effective radiosensitizer for EC.

Efficacy and safety of different radiotherapy doses in neoadjuvant chemoradiotherapy in patients with locally advanced rectal cancer: A retrospective study.

Background: This study aims to compare the efficacy and safety of neoadjuvant chemoradiotherapy (nCRT) with different radiotherapy doses (45Gy and 50.4Gy) in patients with locally advanced rectal cancer (LARC). Methods: Herein, 120 patients with LARC were retrospectively enrolled between January 2016 and June 2021. All patients underwent two courses of induction chemotherapy (XELOX), chemoradiotherapy, and total mesorectum excision (TME). A total of 72 patients received a radiotherapy dose of 50.4 Gy, while 48 patients received a dose of 45 Gy. Surgery was then performed within 5-12 weeks following nCRT. Results: There was no statistically significant difference between the baseline characteristics of the two groups. The rate of good pathological response in the 50.4Gy group was 59.72% (43/72), while in the 45Gy group achieved 64.58% (31/48) (P>0.05). The disease control rate (DCR) in the 50.4Gy group was 88.89% (64/72), compared to 89.58% (43/48) in the 45Gy group (P>0.05). The incidence of adverse reactions for radioactive proctitis, myelosuppression, and intestinal obstruction or perforation differed significantly between the two groups (P<0.05). The anal retention rate in the 50.4Gy group was significantly higher in contrast to the 45Gy group (P<0.05). Conclusions: Patients receiving a radiotherapy dose of 50.4Gy have a better anal retention rate but also a higher incidence of adverse events such as radioactive proctitis, myelosuppression, and intestinal obstruction or perforation, and a comparable prognosis to patients treated with a radiotherapy dose of 45Gy.

Preoperative prediction of clinical and pathological stages for patients with esophageal cancer using PET/CT radiomics.

BACKGROUND: Preoperative stratification is critical for the management of patients with esophageal cancer (EC). To investigate the feasibility and accuracy of PET-CT-based radiomics in preoperative prediction of clinical and pathological stages for patients with EC. METHODS: Histologically confirmed 100 EC patients with preoperative PET-CT images were enrolled retrospectively and randomly divided into training and validation cohorts at a ratio of 7:3. The maximum relevance minimum redundancy (mRMR) was applied to select optimal radiomics features from PET, CT, and fused PET-CT images, respectively. Logistic regression (LR) was applied to classify the T stage (T1,2 vs. T3,4), lymph node metastasis (LNM) (LNM(-) vs. LNM(+)), and pathological state (pstage) (I-II vs. III-IV) with features from CT (CT_LR_Score), PET (PET_LR_Score), fused PET/CT (Fused_LR_Score), and combined CT and PET features (CT + PET_LR_Score), respectively. RESULTS: Seven, 10, and 7 CT features; 7, 8, and 7 PET features; and 3, 6, and 3 fused PET/CT features were selected using mRMR for the prediction of T stage, LNM, and pstage, respectively. The area under curves (AUCs) for T stage, LNM, and pstage prediction in the validation cohorts were 0.846, 0.756, 0.665, and 0.815; 0.769, 0.760, 0.665, and 0.824; and 0.727, 0.785, 0.689, and 0.837 for models of CT_LR_Score, PET_ LR_Score, Fused_ LR_Score, and CT + PET_ LR_Score, respectively. CONCLUSIONS: Accurate prediction ability was observed with combined PET and CT radiomics in the prediction of T stage, LNM, and pstage for EC patients. CRITICAL RELEVANCE STATEMENT: PET/CT radiomics is feasible and promising to stratify stages for esophageal cancer preoperatively. KEY POINTS: • PET-CT radiomics achieved the best performance for Node and pathological stage prediction. • CT radiomics achieved the best AUC for T stage prediction. • PET-CT radiomics is feasible and promising to stratify stages for EC preoperatively.

Efficacy of Concurrent Chemoradiotherapy With S-1 vs Radiotherapy Alone for Older Patients With Esophageal Cancer: A Multicenter Randomized Phase 3 Clinical Trial.

IMPORTANCE: Most older patients with esophageal cancer cannot complete the standard concurrent chemoradiotherapy (CCRT). An effective and tolerable chemoradiotherapy regimen for older patients is needed. OBJECTIVE: To evaluate the efficacy and toxic effects of CCRT with S-1 vs radiotherapy (RT) alone in older patients with esophageal cancer. DESIGN, SETTING, AND PARTICIPANTS: A randomized, open-label, phase 3 clinical trial was conducted at 23 Chinese centers between June 1, 2016, and August 31, 2018. The study enrolled 298 patients aged 70 to 85 years. Eligible participants had histologically confirmed esophageal cancer, stage IB to IVB disease based on the 6th edition of the American Joint Committee on Cancer (stage IVB: only metastasis to the supraclavicular/celiac lymph nodes) and an Eastern Cooperative Oncology Group performance status of 0 to 1. Data analysis was performed from August 1, 2020, to March 10, 2021. INTERVENTIONS: Patients were stratified according to age (<80 vs ≥80 years) and tumor length (<5 vs ≥5 cm) and randomly assigned (1:1) to receive either CCRT with S-1 or RT alone. MAIN OUTCOMES AND MEASURES: The primary end point was the 2-year overall survival rate using intention-to-treat analysis. RESULTS: Of the 298 patients enrolled, 180 (60.4%) were men. The median age was 77 (interquartile range, 74-79) years in the CCRT group and 77 (interquartile range, 74-80) years in the RT alone group. A total of 151 patients (50.7%) had stage III or IV disease. The CCRT group had a significantly higher complete response rate than the RT group (41.6% vs 26.8%; P = .007). Surviving patients had a median follow-up of 33.9 months (interquartile range: 28.5-38.2 months), and the CCRT group had a significantly higher 2-year overall survival rate (53.2% vs 35.8%; hazard ratio, 0.63; 95% CI, 0.47-0.85; P = .002). There were no significant differences in the incidence of grade 3 or higher toxic effects between the CCRT and RT groups except that grade 3 or higher leukopenia occurred in more patients in the CCRT group (9.5% vs 2.7%; P = .01). Treatment-related deaths were observed in 3 patients (2.0%) in the CCRT group and 4 patients (2.7%) in the RT group. CONCLUSIONS AND RELEVANCE: In this phase 3 randomized clinical trial, CCRT with S-1 was tolerable and provided significant benefits over RT alone in older patients with esophageal cancer. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT02813967.

The Role of Adjuvant Chemoradiotherapy Over Radiotherapy After R0 Resection for Stage II-III Esophageal Squamous Cell Carcinoma.

PURPOSE: This study compared the effectiveness and safety of postoperative concurrent chemoradiotherapy (POCRT) containing paclitaxel (PTX) and cisplatin (DDP) with postoperative radiotherapy (PORT) after R0 resection for stage II-III thoracic esophageal squamous cell carcinoma (TESCC). MATERIALS AND METHODS: After propensity score matching (PSM) analysis, 87 TESCC patients treated with PORT were matched 1:1 to 87 patients who received POCRT between July 2012 and December 2018. Radiotherapy was delivered at a dose of 200 cGy per day to a total dose of 5000 cGy. Concurrent chemotherapy consisted of DDP (25 mg/m2) for 3 days plus PTX (135 mg/m2) on day 1 every 3 weeks. RESULTS: Patient- and disease-related characteristics were well-balanced between the two groups. The median overall survival (OS) and disease-free survival (DFS) times were 39.2 and 31.0 months, respectively. The 5-year OS and DFS rates were 31.9% and 19.1% in the PORT group and 45.1% and 35.1% in the POCRT group, respectively. Statistical significance was demonstrated by comparing OS and DFS (P=0.022 and 0.016, respectively). Additionally, subgroup analysis revealed that in node positive TESCC patients, the POCRT group was significantly different from the PORT group regarding OS and DFS (P=0.049 and 0.039, respectively). POCRT decreased distant metastasis over PORT (P=0.044) with manageable toxicities. Multivariate analysis revealed that aside from factors associated with tumor stages, treatment modality was another strong prognostic factor for both OS and DFS (P=0.015 and 0.010, respectively). CONCLUSION: Stage II-III TESCC patients could benefit from POCRT with manageable toxicities. Future well-designed prospective studies are highly warranted to confirm the findings in our report.

Icotinib With Concurrent Radiotherapy vs Radiotherapy Alone in Older Adults With Unresectable Esophageal Squamous Cell Carcinoma: A Phase II Randomized Clinical Trial.

Importance: Palliative radiotherapy (RT) is generally recommended for older patients with esophageal squamous cell carcinoma (ESCC) with poor prognosis. A new combination treatment is therefore needed. Objective: To assess the efficacy and toxicity of RT plus icotinib vs RT alone in older patients with ESCC. Design, Setting, and Participants: This randomized, multicenter, open-label, phase II clinical trial was conducted in China, with enrollment between January 1, 2015, and October 31, 2016. Patients aged 70 years or older with clinical stage T2 to T4, N0/1, M0/1a unresectable (because of comorbidities, T4 disease, unresectable lymph node, or refused surgery) ESCC were randomized 1:1 to receive RT plus icotinib or RT alone. Radiation was prescribed at 60 Gy in 30 fractions in both groups, and icotinib was administered at a dosage of 125 mg 3 times a day in the RT plus icotinib group. The last follow-up was completed on June 30, 2019, and data were analyzed from July 1 to September 30, 2019. Interventions: Patients were randomized to either RT plus icotinib or RT alone. Main Outcomes and Measures: The primary end point was overall survival (OS). Treatment-related toxic effects were evaluated. Immunohistochemistry was performed to analyze epidermal growth factor receptor (EGFR) expression if available. Results: A total of 127 patients (median age, 76 years [range, 70-91 years]; 76 men [59.8%]) were enrolled and were eligible for survival analysis. Median OS was 24.0 (95% CI, 22.2-25.8) months in the RT plus icotinib group vs 16.3 (95% CI, 13.8-18.8) months in the RT group (hazard ratio, 0.53; 95% CI, 0.33-0.87; P = .008). No difference was observed in grades 3 or 4 adverse events. Patients with EGFR overexpression had a significantly better median overall survival (not reached vs 16.3 months [range, 2.6-45.1 months]; P = .03) in the RT plus icotinib group. Conclusions and Relevance: In this randomized clinical trial, icotinib plus RT was well tolerated and improved OS in older patients with ESCC relative to RT alone. Patients with EGFR overexpression benefitted more from icotinib with RT. Trial Registration: ClinicalTrials.gov Identifier: NCT02375581.

Silver Nanowires from Sonication-Induced Scission.

Silver nanowires (AgNWs) have great potential to be used in the flexible electronics industry for their applications in flexible, transparent conductors due to high conductivity and light reflectivity. Those applications always involve size which strongly affects the optical and electrical properties of AgNWs. AgNWs of mean diameter 70 nm and mean length 12.5 µm were achieved by the polyol solvothermal method. Sonication-induced scission was used to obtain the small size AgNWs. The relationship between the size of AgNWs and the ultrasonic time, ultrasonic power, and concentration of AgNWs were studied. The results show that the length of AgNWs gradually reduces with the increase of the ultrasonic time and ultrasonic power, and with the decrease of concentration of AgNWs. Meanwhile, there is an existence of a limiting length below which fragmentation of AgNWs no longer occurs. Further, the mechanics of sonication-induced scission for the fragmentation of AgNWs was discussed.

Silver Nanowire Ink for Flexible Circuit on Textiles.

Low cost electronics implemented in textiles could pave the way to a fully new generation of smart products in the fields of healthcare, sport, fashion, and safety. Although many methods have found their way into the market, many problems still need to be solved and much progress has to be made to enable the commercial exploitation of such products. In this paper, silver nanowires of 60⁻100 nm in diameter and 8⁻15 µm in length were achieved by the polyol solvothermal method, and aqueous silver nanowire conductive inks were prepared with the synthesized silver nanowires as the conductive phase, in the presence of polyaniline, guar, and hydrochloric acid. The conductive inks were printed on cotton fabric substrate by screen printing process. The effects of the amount of silver nanowires, layers of coating, and treatment temperature on the microstructure and electrical properties of samples were investigated by scanning electron microscopy and the four-point probe method. The results show that the conductivity and densification of the samples increased with increased amount of silver nanowires, layers of coating, and treatment temperature. The heat treatment helped to improve densification of the silver nanowires and conductivity of the sample. The resistance of the samples increased after bending due to loosening of the overlap between the silver nanowires.

Optoelectronic and Electrothermal Properties of Transparent Conductive Silver Nanowires Films.

Silver nanowires (AgNWs) show promise for fabricating flexible transparent conductors owing to their excellent conductivity, high transparency, and good mechanical properties. Here, we present the fabrication of transparent films composed of AgNWs with diameters of 20-30 nm and lengths of 25-30 µm on polyethylene terephthalate substrates and glass slides substrates using the Meyer rod method. We systematically investigated the films' optoelectronic and electrothermal properties. The morphology remained intact when heated at 25-150 °C and the AgNWs film showed high conductivity (17.6-14.3 Ω∙sq-1), excellent transmittance (93.9-91.8%) and low surface roughness values (11.2-14.7 nm). When used as a heater, the transparent AgNW conductive film showed rapid heating at low input voltages owing to a uniform heat distribution across the whole substrate surface. Additionally, the conductivity of the film decreased with increasing bending cycle numbers; however, the film still exhibited a good conductivity and heating performances after repeated bending.

Silver Nanowires Inks for Flexible Circuit on Photographic Paper Substrate.

Silver nanowires (AgNWs) have inspired many research interests due to their better properties in optical, electric, and flexible applications. One such exploitable use is as the electrical conductive fillers for print electronics. In this paper, AgNWs with mean a diameter of 80 nm and mean length of 13.49 µm were synthesized using the polyol solvothermal method. A sonication-induced scission process was used to obtain AgNWs with a length range of 7.64⁻11.21 µm. Further AgNWs inks were prepared with the as-synthesized AgNWs as conductive fillers in anhydrous ethanol. The conductive inks were coated on resin coated photographic paper substrate using the knife coating process and dried at room temperature. The effects of the number of layers of AgNWs coating, the concentration of AgNWs, and the length of AgNWs on the microstructure and electrical properties of samples were investigated by scanning electron microscopy and using the four-point probe method. The results show that the conductivity of the AgNWs coating increases with the increase in the number of layers in the AgNWs coating, concentration and length of the AgNWs.

Stereotactic body radiation therapy and thymosin alpha-1-induced anti-tumor effects in heavily pretreated, metastatic esophageal squamous cell carcinoma patients.

This study investigated the anti-tumor effects of stereotactic body radiation therapy (SBRT) with thymosin alpha-1 (Tα1) in heavily pretreated, metastatic esophageal squamous cell carcinoma (mESCC) patients. Thirty-one patients with at least 2 metastatic sites were enrolled. SBRT was delivered with a daily fraction of 5.0 Gy for a total dosage of 25 Gy over one week to one metastatic lesion. Concurrent Tα1 (1.6mg subcutaneously) was administered twice a week with an interval of 3-4 days until tumor progression of other documented metastatic lesions. Anti-tumor effects (the primary endpoint) were evaluated by assessing the CT/MRI response of other distinct measurable lesions. Secondary endpoints included treatment safety, survival outcomes and immune-related blood parameters. This study was registered at ClinicalTrials.gov (NCT 02545751). Partial response occurred in three (9.7%) patients, and 11 (35.5%) patients had stable metastatic disease, which yielded a metastatic-lesion control rate of 45.2%. Seventeen (54.8%) patients were documented to have progressive disease in other metastatic lesions. The median overall survival and abscopal progression free survival (APFS) times were 5.2 and 2.9 months, respectively. Significant differences in survival outcomes were observed between the abscopal control group (without progression in the abscopal lesions at 12 weeks) and the non-control group (P = 0.035 and 0.044, respectively). Treatment-related toxicity was acceptable, and no grade 4 acute toxicity occurred. Immunomonitoring of lymphocytes showed that the proportion of CD8+ T cells after treatment was significantly different between the abscopal control group and the non-control group (P=0.047). In conclusion, the combination of SBRT with Tα1 produced encouraging effects in heavily pretreated, mESCC patients and further research on radiation enhanced immunotherapy is warranted.

Flexible Transparent Conductive Film Based on Random Networks of Silver Nanowires.

We synthesized silver nanowires (AgNWs) with a mean diameter of about 120 nm and 20⁻70 µm in length using a polyol process. The flexible transparent conductive AgNWs films were prepared using the vacuum filtration-transferring process, in which random AgNWs networks were transferred to a polyethylene terephthalate (PET) substrate after being deposited on mixed cellulose esters (MCEs). Furthermore, the photoelectric and mechanical properties of the AgNWs films were studied. The scanning electron microscopy images show that the AgNWs randomly, uniformly distribute on the surface of the PET substrate, which indicates that the AgNWs structure was preserved well after the transfer process. The film with 81% transmittance at 550 nm and sheet resistance about 130 Ω·sq-1 can be obtained. It is sufficient to be used as a flexible transparent conductive film. However, the results of the bending test and tape test show that the adhesion of AgNWs and PET substrate is poor, because the sheet resistance of film increases during the bending test and tape test. The 0.06 W LED lamp with a series fixed on the surface of the AgNWs-PET electrode with conductive adhesive was luminous, and it was still luminous after bent.

Randomised phase III trial of concurrent chemoradiotherapy with extended nodal irradiation and erlotinib in patients with inoperable oesophageal squamous cell cancer.

BACKGROUND: This randomised phase III study was conducted to investigate the efficacy of extended nodal irradiation (ENI) and/or erlotinib in inoperable oesophageal squamous cell cancer (ESCC). PATIENTS AND METHODS: Patients with histologically confirmed locally advanced ESCC or medically inoperable disease were randomly assigned (ratio 1:1:1:1) to one of four treatment groups: group A, radiotherapy adoption of ENI with two cycles of concurrent TP chemotherapy (paclitaxel 135 mg/m2 day 1 and cisplatin 20 mg/m2 days 1-3, every 4 weeks) plus erlotinib (150 mg per day during chemoradiotherapy); group B, radiotherapy adoption of ENI with two cycles of concurrent TP; group C, radiotherapy adoption of conventional field irradiation (CFI) with two cycles of concurrent TP plus erlotinib; group D, radiotherapy adoption of CFI with two cycles of concurrent TP. RESULTS: A total of 352 patients (88 assigned to each treatment group) were enrolled. The 2-year overall survival rates of group A, B, C and D were 57.8%, 49.9%, 44.9% and 38.7%, respectively (P = 0.015). Group A significantly improved 2-year overall survival compared with group D. The ENI significantly improved overall survival in patients with inoperable ESCC (P = 0.014). The addition of erlotinib significantly decreased loco-regional recurrence (P = 0.042). Aside from rash and radiation oesophagitis, the incidence of grade 3 or greater toxicities did not differ among 4 groups. CONCLUSION: Chemoradiotherapy with ENI and erlotinib might represent a substantial improvement on the standard of care for inoperable ESCC. ENI alone should be adopted in concurrent chemoradiotherapy for ESCC patients.