Evaluation of Response to Preoperative Chemotherapy Versus Surgery Alone in Gastroesophageal Cancer: Tumor Resectability, Pathologic Results and Post-Operative Complications.

Aref Kashefi Marandi,Mehdi Jafari,Mahmoud Khodadost,Ahmadreza Soroush,Hossein Mahmoudzade,Ali Ghorbani Abdegah,Abolfazl Shojaiefard

doi:10.7314/apjcp.2016.17.s3.231

Aref Kashefi Marandi, Mehdi Jafari + Show 5 more

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https://doi.org/10.7314/apjcp.2016.17.s3.231

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Abstract

Gastroesophageal cancer is one of the most common types of cancer worldwide. Despite significant developments in management, 5-year survival in the developing world is less than 20 percent. Due to restricted research about the impact of preoperative chemotherapy (POC) on tumor resection, pathological response and postoperative complications in Iran, we designed and implemented ‎the present retrospective cross- sectional study on 156 patients with gastroesophageal cancer (GEc) between 2013 and 2015 at Shariati Hospital of Tehran. Two groups were included, the first group had previously received preoperative chemotherapy and the second group had only undergone surgery. All patients were followed for at least one year after the operation in terms of tumor recurrence, relapse free survival and one-year survival. The two groups were eventually compared regarding tumor resection, pathological response, postoperative complications, recurrence rate and survival. The mean age was 66.5± 7.3 years and 78 percent were male. The tumor resectability, pathological response and postoperative complications in the group which received POC were 93.5%, 21.8% and 12.8%, respectively, and in the surgery alone group figures for tumor resection and postoperative complications were 76% and 29.5%, respectively. Also based on our study the 5-year survival in the POC group was better (79.5% vs. 66.5%). Using standard neoadjuvant regimens (preoperative chemotherapy/ chemoradiotherapy) beforesurgery could increase tumor resectability, pathological response, and improve the general status of the patients. Therefore using POC may be recommended over surgery alone.

Highlights

Gastroesophageal Cancer (GEc) is the eighth most common cancer in the world
A total of 156 patients were examined in the present research. They were placed into two groups the first group included the patients who had received preoperative chemotherapy (POC) (100 mg epirubicin, 200 mg of oxaliplatin, and 400 mg of 5- FU) before the surgery and the second group included the patients who only underwent the operation
Different researches have clearly demonstrated that surgery alone is not enough and all efforts are currently focused on systemic and local treatments before and after the surgery, the aim of prescribing POC is to start the treatment at a time when the body tolerates the drug better and local and distant recurrences are prevented and the possibility that the surgery will succeed increases

Summary

Introduction

Gastroesophageal Cancer (GEc) is the eighth most common cancer in the world. The mortality rate of this cancer is estimated to exceed 407000 per year worldwide (Jemal et al, 2011). Despite outstanding advancements in managing this cancer, its 5- year survival is less than 20 percent (Dikken et al, 2012). Preoperative chemotherapy (POC) based on cisplatin and fluorouracil drugs is often used before the surgery on patients suffering from gastroesophageal (GE) cancer. Numerous clinical trial studies have been conducted with the aim to examine drug doses and drug schedules (phase 1 researches), to evaluate the degree of responding to the drugs (phase 2 researches), and to evaluate the effect of a new medicine or a combination drug during a standard treating period on the overall survival in patients (phase 3 researches) in order to make progress in managing the GE cancer (Ott et al, 2011; Lee et al, 2012)

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