Impact of the Siewert Classification on the Outcome of Patients Treated by Preoperative Chemoradiotherapy for a Nonmetastatic Adenocarcinoma of the Oesophagogastric Junction.

Laurence Moureau-Zabotto,Eric Teissier,Michel Resbeut,David Azria,Steve Ellis,Didier Cowen

doi:10.1155/2015/404203

Laurence Moureau-Zabotto, Eric Teissier + Show 4 more

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https://doi.org/10.1155/2015/404203

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Abstract

The aim of the study is to analyze the impact of the Siewert classification on the pathological complete response (pcR), pattern of failure, and general outcome of patients treated, by preoperative chemoradiotherapy and surgery for an gastroesophageal junction adenocarcinoma (OGJA). From 2000 to 2008, the charts of 68 patients were retrospectively reviewed. Tumor staging reported was UST1/T2/T3/T4/unknown, respectively, n = 1/7/54/5/1 patients, and N0/N1/unknown, respectively, n = 9/58/1 patients. Patients received primary external-beam radiotherapy with concurrent chemotherapy followed by surgical resection (Siewert I: upper oesogastrectomy; Siewert II/III: total gastrectomy with lower oesophagectomy). Overall survival (OS), overall relapse rate (ORR), cumulative rate of local (CRLR), nodal (CRNR), and metastatic (CRMR) relapse, and their prognostic factors were retrospectively analyzed. Median follow-up was 77.5 months. Median OS was 41.7 ± 5.2 months. The 3-year ORR was 48%. Using univariate analysis ORR was significantly increased for patients with Siewert II/III compared to Siewert I tumors (27.3% versus 62%, p = 0.047). Siewert I tumors had also statistically lower CRNR and CRMR compared to Siewert II/III tumors (0/9.1% versus 41.3/60.2% resp., p = 0.012), despite an equivalent cumulative rate of local relapse and pathological complete response rate between the three groups. For OGJA treated with preoperative CRT and surgery, ORR and CRMR were lower for patients with Siewert I tumors in comparison with Siewert II/III tumors.

Highlights

Oesophageal and gastroesophageal junction cancer is the eighth most common form of cancer, with almost 482000 new cases and 407000 deaths in the world in 2008 [1]
Between January 2000 and December 2008, 159 patients were treated by radiotherapy with or without +/− concomitant chemotherapy for a nonmetastatic adenocarcinoma of the gastroesophageal junction in four French cancer centers
During this period and before the publication of the MAGIC Trial and the French FFCD Trial results [13, 14], all patients requiring neoadjuvant treatment for a nonmetastatic adenocarcinoma of the gastroesophageal junction were treated by neoadjuvant radiotherapy with or without +/− concomitant chemotherapy in these cancer centers

Summary

Introduction

Oesophageal and gastroesophageal junction cancer is the eighth most common form of cancer, with almost 482000 new cases and 407000 deaths in the world in 2008 [1]. The incidence of adenocarcinoma has increased in compaison to all other histology [2, 3]. Early-stage localized disease with no evidence of nodal spread and with invasion confined to the submucosa has a good prognosis after complete local resection, more advanced lesions benefit from combined modality therapy with more extensive resection to ensure negative margins, including lymph node dissection. Meta-analysis suggests an evident survival benefit for preoperative chemoradiotherapy and, to a lesser extent, for chemotherapy in patients with adenocarcinoma of the oesophagus. In this meta-analysis, preoperative radiochemotherapy increased survival whatever the histological subtypes, whereas the benefit in survival for neoadjuvant chemotherapy was observed only for adenocarcinomas [8, 9]

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