P-0102 Postoperative Radiochemotherapy for Adenocarcinomas of The Gastroesophageal Junction

Abstract

Listen

Translate article

IntroductionAdenocarcinomas of gastroesophageal junction (GEJ) represent a heterogenic group of tumors with poor prognosis. The principal treatment of nonmetastatic GEJ is surgical resection with 5-year survival rate of approximately 20%. It is clear that the patients with T2, T3 and/or N+ disease need additional treatment. In our institution, nowadays preoperative chemoradiotherapy (RCT) is the treatment of choice. However, there are still patients with locoregionally advanced disease who first undergo surgical resection followed by postoperative RCT. MethodsIn the period from January 2005 to November 2011, 72 patients (56 males and 16 females; aged 33-77 years, mean age 60 years) were treated for non-metastatic adenocarcinoma of GEJ (stage IIa- IIIc) with postoperative RCT. Proximal subtotal resection of the stomach, total resection of the stomach, transhiatal esophagogastrectomy and transthoracal esophagogastrectomy were performed in 4.2%, 69.4%, 19.5% and 6.9% of patients, respectively. Radical resection was performed in 58 (80.6%) patients and in the remaining 14 (19.4%) patients non-radical surgery was performed. Most frequently (in 47.3%), the primary tumor originated in the subcardial stomach (Siewert III). The tumor was staged as pT2 in 33.3%, as pT3 in 58.4% and as pT4 in 8.3% of pateints. Sixty-five patients (92.9%) had N+ disease. Planned treatment schedule consisted of 3D conformal external beam radiotherapy (45 Gy in 25 fractions), with six cycles of chemotherapy (CT) with 5-FU (1000 mg/m2) through 96 hours and cisplatin (75 mg/m2) in bolus on day 2 of each cycle. Radiotherapy was started concomitantly with the second cycle of CT. The main endpoints of this study were as follows: locoregional control (LRC); disease-free survival (DFS); disease-specific survival (DSS) and overall survival (OS) and the rates of acute side-effects were estimated. ResultsTwenty-eight patients (38.9%) completed the treatment according to the protocol. Sixty-three patients (87.5%) reached the total radiation dose of 45 Gy. In six patients (8.3%) the total dose was lower (9-27 Gy) and three (4.2%) patients did not even start with the radiotherapy because of the side effects during the first cycle of CT. All six cycles of CT could be administered in only 28 patients (38.9%). No death occurred due to therapy. Acute toxicity grade 3 or more, such as stomatitis, dysphagia, nausea and vomiting, and infection, occurred in 2.9 %, 34.3%, 38.6% and 41.5% of patients, respectively. The median follow-up time of all 72 patients was 16 months (range: 4-64 months). On the close-out date, 29 (40.3%) patients were still alive, 22 (30.6%) of them being with no signs of disease. Thirty-nine (54.2%) patients died from GEJ adenocarcinoma. After adjuvant RCT, local and/or regional recurrence developed in two (2.8%) patients, locoregional and systemic disease was observed in five (6.9%) patients, and systemic disease alone developed in 39 (54.2%) patients. The 3-year LRC, DFS, DSS and OS were 78.3%, 25.5%, 35.9%, and 33.9%, respectively. ConclusionPostoperative RCT with 5-FU and cisplatin is feasible, although with high toxicity and therefore should be reserved only for selected group of patients, who first underwent surgery due to different reasons.