| Inclusion Criteria: | 1) >/= 18 years old.
2) ECOG/Zubrod Performance Status 0-1
3) Biopsy -proven resectable primary (nonrecurrent) adenocarcinoma of the distal esophagus or GE junction (Siewert Type I or II). Siewert Type definitions: Siewert Type I: adenocarcinoma of the distal esophagus Siewert Type II: adenocarcinoma of the esophago-gastric junction/real cardia
4) Pre-registration EUS, CT of chest and upper abdomen, and PET must support a clinical stage ofT1-3N1M0, T3N0M0 or T1-3N0-1M1a (celiac adenopathy must be </= 2 cm by EUS). Clinically staged T1N0M0 and T2N0M0 tumors are not eligible. N1 does not require biopsy/FNA. Note: Patients requiring a stent for nutrition must have staging examinations and scans completed before stent placement.
5) No definitive radiological evidence of distant metastases.
6) No pre-existing grade 2 or greater peripheral neuropathy of any etiology.
7) Adequate bone marrow, hepatic and renal function prior to registration: WBC >/= 3000/mm^3, ANC >/= 1,500/mm^3, Hemoglobin >/= 9.5 mg/dl, Platelet count >/= 100,000/mm^3, Creatinine </= 1.5 mg/dl, Total Bilirubin </= 3 mg/dl, AST (SGOT) </= 2.0 times ULN, ALT (SGPT) </= 2.0 times ULN, Alkaline Phosphatase </= 2.0 times ULN, Albumin >/= 2.0 g/dl or prealbumin >/= 15 mg/dl, Magnesium >/= LLN
8) Patient must be evaluated before registration by medical oncologist, radiation oncologist and surgeon and deemed fit for protocol therapy and surgery.
9) No prior invasive malignancy, unless disease-free for >/= 5 years (Exceptions: non-melanoma skin cancer, in-situ cancers).
10) Non-pregnant and non-breast-feeding. Female participants of child-bearing potential must have a negative urine or serum pregnancy test prior to registration. Perimenopausal participants must be amenorrheic >/= 12 months to be considered not of childbearing potential. All patients of reproductive potential must agree to use an effective method of birth-control while receiving study therapy and for six months after completion of therapy.
11) No prior chest or upper abdomen radiotherapy; prior therapy with cisplatin, docetaxel, panitumumab or other anti-EGFR therapy; or prior esophageal or gastric surgery. (Exception: prior surgery to treat reflux disease)
12) No uncontrolled intercurrent illness including, but not limited to, ongoing or active infection, symptomatic congestive heart failure, unstable angina pectoris, cardiac arrhythmia, or psychiatric illness/social situations that would limit compliance with study requirements.
13) No history of interstitial lung disease e.g. pneumonitis or pulmonary fibrosis or any evidence of interstitial lung disease on baseline chest CT scan.
14) No history of any medical or psychiatric condition or laboratory abnormality that in the opinion of the investigator may increase the risks associated with the study participation or investigational product(s) administration or may interfere with the interpretation of the results. |