beginning on Day 1 and Day 21, concurrent with a split course of accelerated fractionation radiation (1.5 grays [Gy] twice daily, to a total dose of 45 Gy). All 1 Department of Hematology and Medical Onpatients were subsequently referred for surgical resection. A single, identical postcology, Cleveland Clinic Foundation, Cleveland, operative course of chemotherapy and 24 Gy accelerated fractionation radiation Ohio.was planned for patients with residual tumor at surgery. 2 Department of Thoracic and Cardiovascular RESULTS. Seventy-four patients were entered on this study; 72 patients were conSurgery, Cleveland Clinic Foundation, Cleveland, sidered eligible and evaluable. Induction toxicity included nausea (85%), increased Ohio.dysphagia (90%), neutropenia (õ1000/mm 3 ) (43%), thrombocytopenia (õ20,000/ 3 Department of Radiation Oncology, Cleveland mm 3 ) (10%), and reversible nephrotoxicity (8%). Sixty-seven patients (93%) underClinic Foundation, Cleveland, Ohio.went surgery, and 65 (90%) were found to have resectable tumors. Twelve of these patients (18%) died perioperatively, and 18 (27%) had no residual pathologic evi-4 Department of Gastroenterology, Cleveland dence of disease. Resolution of symptoms and normalization of radiographic studClinic Foundation, Cleveland, Ohio.ies, endoscopy, or esophageal ultrasound did not identify pathologic complete responders accurately. No patient completing induction therapy and surgery experienced a locoregional recurrence. The Kaplan-Meier 4-year projected recurrence free and overall survival rates were 49% and 44%, respectively.
CONCLUSIONS.Although this regimen is feasible, there was significant preoperative toxicity and perioperative mortality. Nonetheless, the recurrence free and overall survival rates were encouraging. However, no staging tool can predict a pathologic complete response after induction therapy accurately, suggesting a continued need for surgical resection. tendency for patients with this neoplasm to present late in their disease course, only after the development of dysphagia, a manifestation