Ponnandai Somasundar, MD; Charu Taneja MD; Dimitrios Katsarelias, MD; Michael Vezeridis MD; Harold Wanebo MD Department of Surgery, Roger Williams Medical Center, Providence, RI 02908 Introduction: The overall survival of esophageal cancer continues to be poor. In spite of numerous adjuvant studies in esophageal cancer, there is still limited data to support a survival benefit. We have reviewed our experience with resectable esophageal cancer to assess possible benefit of cisplatin-based neoadjuvant therapy. Methods: We reviewed data from 170 patients diagnosed with esophagus cancer (including gastro-esophageal junction cancers) treated between 1989-99. Complete data was available for 136 patients. Fifty-four (40%) patients were treated with an esophago-gastrectomy with negative margins. During the last 5 years, most patients with Stage II lesions were treated with preoperative chemo-RT (Cisplatin + 5-FU or paclitaxel, with 45 Gy). Results: The site of the lesion was distal esophagus and GE junction in 94 patients (70%), mid -esophagus in 28 (20.5%), and proximal esophagus in 14 (10%). Adenocarcinoma was the prevalent histologic type in 61% patients, with squamous cell Ca accounting for almost all the other cases. The mean overall survival was 8 months compared to 22 months in the curative resection group. The 3 and 5 yr. survival was 30%/21% (Neoadjuvant) vs. 26%/13% (Surgery alone) P<0.05. Of the 23 patients receiving neo-adjuvant therapy, nine patients (40%) were down-staged based on pathological findings, with a complete response in 7 patients (30%). The peri-operative mortality in all patients having surgery was 2% and the morbidity was 40.7 %. Conclusions: Although esophageal cancer has an overall poor prognosis, and only 40% are amenable to curative surgery, neoadjuvant therapy appears to increase long term survival in resectable high stage patients.