Phase I Dose Escalation of Stereotactic Radiosurgical Boost for Locally Advanced Esophageal Cancer

• A complete assessment of all pathologic specimens (biopsy and definitive surgical) to document the histology, grade, depth of invasion, lymphovascular or perineural invasion. [ Time Frame: unknown ] [ Designated as safety issue: No ]
  
• The inked margins on the definitive surgical specimen will be inked and margin status, size of the tumor, evidence of residual tumor will be recorded. [ Time Frame: unknown ] [ Designated as safety issue: No ]
  
• Patients' responses to therapy will be evaluated clinically after completion of their neoadjuvant chemoradiation. [ Time Frame: after completion of their neoadjuvant chemoradiation ] [ Designated as safety issue: No ]
  

• Physical exam [ Time Frame: Once every three months for two years, then every six months for three years and then once a year. ] [ Designated as safety issue: No ]
  
• CT scan [ Time Frame: Three months after completion of therapy, then every six months for three years then once a year for until 5 years from completion of therapy. ] [ Designated as safety issue: No ]
  
• Upper endoscopy [ Time Frame: Three months after completion of therapy, then every six months for three years then once a year for until 5 years from completion of therapy. ] [ Designated as safety issue: No ]
  
• Patterns of failure and the 2-year progression-free survival (PFS) rate. [ Time Frame: 2 years ] [ Designated as safety issue: No ]
  

Drug: Capecitabine (Xeloda)
PO bid daily on RT days: 500mg & 150mg tabs for dose 825mg/m2 bid AM/PM (total daily dose 1650mg/m2)
Other Name: Xeloda
Drug: [18-F] Fluorodeoxyglucose (FDG)
5-10 mCi IV administration
Other Name: Fluorodeoxyglucose
Drug: 5-Fluorouracil (5-FU)
200mg/m2 continuous venous infusion
Other Names:
• 5-Fluorouracil
• Carac
• Efudix
• Efudex
• Fluoroplex
Drug: Carboplatin
AUC 2, based onCalvert formula IV infusion
Other Names:
• cis-Diammine
• Paraplatin
• Paraplatin-AQ

This study will evaluate the safety and feasibility of delivering radiation dose escalation using hypofractionated radiosurgery in locally advanced esophageal cancer. The dose escalation will be delivered using an image-guided radiosurgical boost to the tumor volume, following a neoadjuvant regimen consisting of oxaliplatin, capecitabine, and conventionally fractionated radiotherapy. In addition, we will evaluate the utility of PET-FDG before and after neoadjuvant chemoradiation in predicting the pathologic response to pre-operative treatment. We will study the effect of this regimen on pathologic complete response rates and complete resection rates at surgery among patients with locally advanced esophageal cancer and determine patterns of failure and rates of progression-free survival. Finally, we plan to characterize in an exploratory manner the correlation between molecular markers and pathologic findings following pre-operative chemoradiation.