1. Perioperative Complications after Neoadjuvant Chemoradiation for Locally-Advanced Esophageal Cancer: A Comparison of Platinum/5-FU and Carboplatin/Paclitaxel
Abigail T. Berman1; Andrew R. Barsky2; Rosemarie Mick3; James M. Metz1; Edgar Ben-Josef1; Ursina Teitelbaum4; Noel Williams5; John C. Kucharczuk5; David J. Margolis3; John P. Plastaras1 
1Department of Radiation Oncology
2Perelman School of Medicine
3Clinical Center for Biostatistics and Epidemiology
5Division of Hematology/Oncology, Department of Medicine
5Division of Thoracic Surgery, Department of Surgery
Perelman School of Medicine; University of Pennsylvania, Philadelphia, PA, USA

2. The optimal chemotherapy regimen is not clearly defined.
Introduction
Standard treatment paradigm for locally-advanced esophageal cancer (LAEC)” trimodality therapy, with neoadjuvant chemoradiation (nCRT) followed by surgery
The optimal chemotherapy regimen is not clearly defined.
CALGB 9781: nCRT with cis-platinum and 5-FU (PF) improved the 5-year OS by 23% over surgery alone
The recent CROSS trial showed a median overall survival (OS) benefit of 49.4 vs 20 mos for nCRT with carboplatin-paclitaxel (PT) versus surgery alone
Postoperative morbidity and mortality is highly clinically- significant, with rates of 50-60% and 0-15%, respectively
In the absence of randomized data of PF versus PT, we sought out to investigate if there are any significant differences in the perioperative morbidity of PF vs PT for nCRT prior to esophagectomy.

3. Methods
Retrospective cohort design with subjects as LAEC patients diagnosed between July and October 2013
Perioperative complications were defined as:
pulmonary (pneumonia, ARDS, pulmonary effusion, respiratory insufficiency)
cardiac (atrial fibrillation or arrhythmia, myocardial infarction, heart failure)
GI (anastamotic leak, ileus, fistula, J- tube complications)
hospital readmission to reflect composite toxicity
Significant secular trend for PT vs PF use across years from

4. Results Median follow-up was 24 months.PT PF
n=48
n=52
Age (y)
Median 65
Range
46-78
16-78
Gender
Male
41 (85)
45 (87)
Female
7 (15)
7 (13)
Race
Caucasian
46 (96)
47 (90)
Black
2 (4)
3 (6)
Asian
Initial ECOG PS
0-1
47 (98)
50 (96) 2
1 (2)
Smoking History
Never
9 (19)
18 (35)
Former
36 (75)
30 (57)
Current
4 (8)
Clinical Stage II
23 (48)
19 (37)
III
27 (52) IV
6 (12)
Histologic Type
Adenocarcinoma
45 (94)
48 (92)
Squamous cell carcinoma
Location
Middle
Distal/GE junction
Type of Surgery
Transhiatal Esopahgectomy
24 (50)
38 (73)
Ivor-Lewis Procedure
14 (27)
Median RT Dose
50.4
( )
( )
End RT to Surgery (d) 52 45
(29-390)
(29-101)
Median follow-up was 24 months.
No significant differences between groups in baseline characteristics
pCR rate: 24% PF vs. 25% PT, p=0.91

5. Results % for PF % for PT PF vs. PT Odds Ratio (OR)
% for PF
% for PT
PF vs. PT
Odds Ratio (OR)
Confidence Interval
Readmission 42 22
2.42
Pulmonary Complications 29 37
0.72
Cardiac Complications 34 33
1.06 G5
GI Complications 52 46
1.28

6. Conclusion and Discussion