To determine the maximal tolerated dose (MTD) of chemoradiation using a simultaneous integrated boost to dose escalate the gross tumor volume, in patients with esophageal cancer. The MTD is defined as highest level of Common Terminology Criteria for Adverse Events (CTCAE) v3 grade 3 acute radiation toxicity of esophagitis either during treatment or up to 2 weeks after completion of radiation therapy. The maximum acceptable toxicity rate for this study will be is 30%. This rate was based on what we would consider as acceptable based on out prior rate of grade 3 esophagitis rate seen in the last 3 years at MD Anderson of 16%. This compares favorable compared to the historic rates of other institutions such as the CALGB 9781 which has a 27% rate. We assume the prior distribution of the toxicity rate is beta (0.5, 0.5).
· To evaluate whether using a simultaneous integrated boost to dose escalate the gross tumor volume, in patients with esophageal cancer can improve tumor response (CR+PR) rate, as defined by EUS and or positron emission tomography (PET) scan.
· Evaluate for tissue biomarkers which may be used to predict local versus distant failures.