Surgery With or Without Chemotherapy and Radiation Therapy in Treating Patients With Cancer of the Esophagus

You may be eligible if

• 1. Patients with histologically documented untreated squamous cell carcinoma or adenocarcinoma of the thoracic esophagus (below 20 cm) or gastro-esophageal junction and with less than 2 cm distal spread into the gastric cardia were eligible.
• 2. No evidence of distant metastatic disease by history and physical examination
• 3. Upper endoscopy with biopsy, computed tomography (CT) of the chest and upper abdomen, and pulmonary function studies are required.
• 4. Bone scan is required for alkaline phosphatase more than 3X the institutional normal value.
• 5. Bronchoscopy is required if the primary tumor was adjacent to the trachea or left main stem bronchus.
• 6. Patients are required to have:
• * granulocyte counts ≥1,800/mL
• * platelet count ≥ 100,000/mL
• * creatinine clearance ≥ 50 mL/min
• 7. Esophageal ultrasound (EUS) and preresection staging by thoracoscopy (ts) and laparoscopy/minilaparotomy (ls), including biopsy of celiac axis and lesser curvature are recommended
• 8. Tumors must be considered surgically resectable (T1-3, NX), including regional thoracic lymph node (N1) metastases.
• 9. Patients with supraclavicular lymph nodes measuring ≤ 1.5 cm by CT (not palpable) are eligible.
• 10. Patients with lymph node metastases to levels 15 to 20 (predominantly celiac axis and paracardial nodes) ≤1.5 cm by CT.
• 11. Patients may not have previously received chemotherapy or radiation therapy for this tumor or any radiation therapy that would overlap the radiation fields required for this malignancy.
• 13. There can be no other serious illness that would limit survival to less than 2 years, or psychiatric condition that would prevent compliance with treatment or informed consent. Patients with uncontrolled or severe cardio- vascular disease,pulmonary disease, oractive infections are excluded.
• 14. Pregnant patients are excluded.
• 15. Informed consent is required for all patients.