Positron emission tomography/computed tomography (PET/CT) was obtained prior to and after completion

of chemoradiotherapy (CRT). The majority of patients underwent evaluation with computed tomography (CT) with oral and intravenous contrast of the chest, abdomen and pelvis. For patients who underwent endoscopy at outside institutions, repeat endoscopy was performed on the discretion of the surgeon as Inhibitors,research,lifescience,medical was endoscopic ultrasound (EUS) with or without biopsy. All outside pathology and radiology was reviewed. All patients were discussed at a multidisciplinary conference with participation of all sub-specialty disciplines involved in the care of esophageal and GEJ carcinomas and treatment recommendations reviewed. All patients were screened and high risk anesthesia consults Inhibitors,research,lifescience,medical were obtained for those patients with significant co-morbidities. Preoperative cardiac stratification and pulmonary function tests were obtained when indicated. Patients were excluded if they were considered non-surgical candidates on the basis of medical co-morbidities, were previously treated with chemotherapy or radiation within the treatment area, were considered unresectable or had metastatic disease, or if they had lymphadenopathy outside the area of planned resection. Patient Inhibitors,research,lifescience,medical data reviewed included complete history/physical

examination, upper endoscopy/EUS, biopsy results, CT chest/abdomen Inhibitors,research,lifescience,medical and pelvis with oral and IV contrast, PET/CT, and laboratory results including albumin and protein. Treatment All patients received concurrent CRT followed by Ivor-Lewis esophagogastrectomy (ILE). Chemotherapy consisted of weekly administration of paclitaxel 50 mg/m2 and carboplatin AUC =2 given intravenously with total infusion time of 2 hours for an average of

6 weeks. Inhibitors,research,lifescience,medical These were administered on days 1, 8, 15, 22, 29 and 36. Patients were premedicated with dexamethasone 10 mg, diphenhydramine 50 mg, famotidine 20 mg, and palonosetron 0.25 mg as well as hydrated with intravenous fluid prior to the administration of chemotherapeutic medications. Conformal radiotherapy to a total dose of 50.4 Gy in 28 fractions was delivered. All patients were treated using volumetric modulated arc therapy (VMAT) with 6 MV photons. Volumes were designed to include gross tumor and nodal disease Calpain as noted on endoscopy and on imaging studies, regional nodes and the celiac axis with margin. Organs at risk for treatment find protocol planning included lungs, heart, spinal cord, uninvolved esophagus and stomach, liver, and kidneys. Heterogeneity corrections were used in treatment planning using Eclipse Treatment Planning System version 8.5 (Varian Medical Systems, Palo Alto, CA). Dose was prescribed to the planning target volume (PTV) so that at least 95% of the PTV received 99% of prescription dose with dose constraint of 93%≤ PTV ≤107%. One or two arcs were used as needed to meet the above target constraints.