title: Neoadjuvant chemoradiotherapy for esophageal/gastroesophageal carcinoma.
abstract: BACKGROUND
  Esophageal/gastroesophageal junction (GEJ) adenocarcinoma is increasingly treated with trimodality therapy. We present our experience using carboplatin/paclitaxel and radiotherapy followed by surgery.
  
  
  METHODS
  Consecutive patients with distal esophageal/GEJ adenocarcinoma (≥T2 or N+) treated from July 2010 to October 2011 were identified. Treatment included neoadjuvant carboplatin/paclitaxel with concurrent radiotherapy (CRT) to 50.4 Gy using an IMRT technique and then Ivor Lewis esophagogastrectomy (ILE). PET/CT was performed prior to and after CRT. Patient/treatment characteristics and tumor response were analyzed.
  
  
  RESULTS
  Over this timeframe, 16 patients completed trimodality therapy. All were male, median age of 60 years (45-72 years). All tumors were grade 2-3 with mean tumor length of 4.4 cm (1-9 cm). A median of 6 cycles (5-9 cycles) neoadjuvant carboplatin/paclitaxel were administered. Average time from diagnosis to CRT completion was 76 days (44-141 days) and 60 days (35-92 days) from CRT end to surgery. Neoadjuvant CRT was well tolerated with mean weight loss of 3.9 kg. All pts had R0 resections. No anastomotic leaks or perioperative mortality occurred. Mean hospital stay was 13 days (8-28 days). Pathologic complete response (pCR) was seen in 38% of patients, microscopic residual disease (isolated tumor cells or <2 mm) in 31%, and macroscopic residual disease remained in 31%. Mean SUV reduction was 41% (0-100%). Of 11 patients with ≥35% SUV decrease, 45% had pCR and 27% had microscopic residual disease. Three patients had signet ring features. Of these, 2 had no SUV reduction and all had gross residual disease, including the only patient with positive nodal disease.
  
  
  CONCLUSIONS
  Trimodality therapy utilizing concurrent carboplatin/paclitaxel and radiotherapy to 50.4 Gy followed by surgery was well tolerated and resulted in significant pathologic complete response or minimal residual disease. Further investigation of predictive factors for response is needed to best tailor therapy in the management of esophageal/GEJ adenocarcinoma.
authors.affiliation: Surgical Oncology, Roswell Park Cancer Institute, Elm and Carlton Streets, Buffalo, NY 14263, USA.
authors.forename: Timothy A
authors.initials: TA
authors.lastname: Platz
authors.forename: Steven J
authors.initials: SJ
authors.lastname: Nurkin
authors.forename: Mei Ka
authors.initials: MK
authors.lastname: Fong
authors.forename: Adrienne
authors.initials: A
authors.lastname: Groman
authors.forename: Leayn
authors.initials: L
authors.lastname: Flaherty
authors.forename: Usha
authors.initials: U
authors.lastname: Malhotra
authors.forename: Charles M
authors.initials: CM
authors.lastname: Levea
authors.forename: Sai
authors.initials: S
authors.lastname: Yendamuri
authors.forename: Graham W
authors.initials: GW
authors.lastname: Warren
authors.forename: Hector R
authors.initials: HR
authors.lastname: Nava
authors.forename: Kilian S
authors.initials: KS
authors.lastname: May
keywords: Esophageal adenocarcinoma; pathologic response; standard uptake value (SUV); trimodality therapy