Dose Escalation of Neoadjuvant Proton Beam Radiotherapy With Concurrent Chemotherapy in Locally Advanced Esophageal Cancer

Inclusion Criteria:

- Patients with a histologic diagnosis of adenocarcinoma of the esophagus located distal
to the carina

- Patients with AJCC 7th edition clinical stage IIB-IIIC

- Patient must be >18 years of age.

- Patients must have an ECOG Performance Status of 0-1

- Patients must be able to provide informed consent.

- Patients must be surgical candidates with adequate hematologic, renal, hepatic and
pulmonary function

- serum AST and ALT < 2 times the upper limit of normal

- Patients must have bilirubin < 1.5 × normal.

- WBC > 3000/mm3, platelets > 100,000 mm3.

- Hemoglobin > 10 g/dL serum creatinine < 1.5 times the upper limit of normal

- Women of child-bearing potential as long as she agrees to use a recognized method of
birth control (e.g. oral contraceptive, IUD, condoms or other barrier methods etc.).
Hysterectomy or menopause must be clinically documented.

Exclusion Criteria:

- Patients with primary tumors exceeding 8 cm in length or 5 cm in width ( length should
be measured by endoscopic findings, width should be measured by diagnostic CT or CT
portion of PET/CT)

- Patients with primary tumors located at or above the carina

- Prior or simultaneous malignancies within the past two years (other than cutaneous
squamous or basal cell carcinoma, melanoma in situ or thyroid carcinoma)

- Pregnant women, women planning to become pregnant and women that are nursing