Aggressive multi-modal therapy with CRT followed by surgery in cT4 SCC of the thoracic esophagus is feasible. Surgery should be limited to patients with significant response to induction treatment and a high probability of R0 resection.

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BACKGROUND: This phase 2 study was aimed at defining the pathological response rate of a neoadjuvant schedule including weekly docetaxel and cisplatin, continuous infusion (c.i.) of 5-fluorouracil (5-FU) and concomitant radiotherapy (RT) in untreated stage II-III adenocarcinoma and squamous cell carcinoma of mid-distal thoracic esophagus. METHODS: The schedule consisted of a first phase of chemotherapy alone and of a second phase of concurrent chemoradiation. Doses were as follows: docetaxel 35 mg/m 2 and cisplatin 25 mg/m 2 on days 1, 8,15,29,36,43, 50, and 57 plus 5-FU c.i. (180 mg/m 2 on days 1-21 and 150 mg/m 2 on days 29-63); RT (50 Gy) started at day 29. Surgery was planned 6 to 8 weeks after the completion of chemoradiation. RESULTS: A total of 74 patients were enrolled; pathological complete remission (pCR) was found in 47% (35 of 74) and near pCR (microfoci of tumor cells on the primary tumor without lymph nodal metastases) (pnCR) in 15% of the patients (11 of 74). Grade 3-4 neutropenia, nonhematological toxicity, and toxic deaths occurred in 13.5%, 32.4%, and 4% of the patients, respectively. Median follow-up was 55 months (range, 3-108 months). Median survival of all 74 patients was 55 months, whereas it was not reached in the pCR subset. The 3-and 5-year survival rates were, respectively, 83% and 77% for pCR, 73% and 44% for pnCR, and 21% and 14% for Residual Tumor subsets (P <.001). CON-CLUSIONS: This study shows that 1) this intensive weekly schedule produced a high pathological response rate, 2) responders had

This schedule represents a feasible treatment and the high pathological response rate is extremely encouraging; the doses found in the last dose-level are the basis for an ongoing phase II study at our institution.

We investigated the accuracy of the Hodkinson abbreviated mental test (AMT) as a screening instrument for dementia in an Italian population. The AMT was administered by nonmedical personnel to 124 subjects > 59 years old. Each subject independently underwent a clinical evaluation for dementia (DSM-III criteria), and scores on the AMT were compared to corresponding clinical diagnoses (standard for comparison). Twenty of the 124 subjects were found to be affected by dementia upon clinical investigation. Although a score of 6 on the AMT showed the best combination of sensitivity (90%) and specificity (89%), only a score of 7 yielded 100% sensitivity (71% specificity). Specificity was higher in men, younger, and more educated subjects.