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Upper GI: Definitive chemoRT for oesophageal SCC - dose and concurrent chemotherapy

Free question published 11 October 2026

Upper GIDefinitive chemoRT for oesophageal SCC - dose and concurrent chemotherapy

A 70-year-old woman with a cT3N1M0 squamous cell carcinoma of the upper oesophagus is unsuitable for surgery and is to receive definitive chemoradiotherapy with curative intent. The clinical oncologist plans a standard non-surgical radical schedule. Which radiotherapy dose with concurrent chemotherapy is most consistent with current UK practice for definitive chemoradiotherapy of oesophageal squamous cell carcinoma?

  1. A66 Gy in 33 fractions with concurrent cisplatin
  2. B30 Gy in 10 fractions with no concurrent chemotherapy
  3. C41.4 Gy in 23 fractions with concurrent carboplatin-paclitaxel
  4. D50-50.4 Gy in 25-28 fractions with concurrent platinum-fluoropyrimidine chemotherapy
  5. E20 Gy in 5 fractions with concurrent capecitabine

Why D is correct

Standard definitive (radical) chemoradiotherapy for oesophageal cancer in the UK uses approximately 50-50.4 Gy in 25-28 fractions with concurrent chemotherapy (historically cisplatin-fluorouracil, increasingly carboplatin-paclitaxel). NICE NG83 notes that standard radical treatment for oesophageal squamous cell carcinoma is usually chemoradiotherapy, associated with a median survival of 12-18 months. Dose escalation above this has not improved outcomes (SCOPE1/ARTDECO).

And why the others are not

  • ADose escalation to 66 Gy has not improved survival over standard-dose chemoradiotherapy and increases toxicity; it is not standard.
  • B30 Gy in 10 fractions without chemotherapy is a palliative schedule, not curative-intent definitive chemoradiotherapy.
  • C41.4 Gy in 23 fractions is the neoadjuvant CROSS dose intended to be followed by surgery, not a definitive radical schedule.
  • E20 Gy in 5 fractions is a palliative dose for symptom control, not radical treatment.

Source NICE NG83 - Oesophago-gastric cancer: assessment and management in adults — National Institute for Health and Care Excellence. Oesophago-gastric cancer: assessment and management in adults. NICE guideline NG83. Published 24 January 2018.

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