Perioperative management of patients with distal esophagus and gastroesophageal junction tumors: Three years of results.

Abstract

e14631 Background: In patients with operable gastroesophageal adenocarcinoma, a perioperative regimen ECF significantly improved survival (MAGIC trial - Cunnigham 2006) and has been accepted as standard treatment option. In our study we present experience with modified MAGIC protocol in patients with lower esophagus or GE junction tumors. Methods: 67 patients (pts) (60 men, 7 women), median age 59 years (37-74), with resectable adenocarcinoma in lower esophagus or gastroesophageal junction were included in period 01 Mar 2008 – 15 Jun 2010. Fifty one (76%) pts had clinical stage nodal positive. Chemotherapy (CT) consisted of three preoperative and three postoperative cycles of intravenous epirubicin (50 mg/m2) and cisplatin (60 mg/m2) on day 1, and a continuous infusion of fluorouracil (200 mg/m2 per day) for 21 days or oral capecitabine 1000 mg/m2 for 14 days. Postoperative radiochemotherapy (CRT) with fluorouracil or capecitabine after the end of CT was indicated in pts with two and more positive lymphnodes in surgical specimen if feasible. Results: Preoperative CT completed 64 (94%) pts, 52 (78%) had surgery, 46 (69%) had radical resection with 3 cases of complete pathological response, 22 pts had pN0 and 21 pts pN plus finding. Postoperative CT was started in 39 (58%) pts and was completed in 32 (48%) pts. 10 (22%) pts had postoperative CRT. Adverse events grade 3-4 were: neutropenia 10%, vomiting 8%, fatigue 5%, diarrhea 3%. Reasons for omitting surgery in 15 (22%) pts were: progression in 7 pts, medically unfit in 4 pts, other in 4 pts. With a median follow-up of 31 months (17-47) there were recurrences in 35 (52%) of all pts, in 5 (7%) pts locoregional only, in 7 (11%) distal plus locoregional and in 23 (34%) pts distal metastases. Recurrence rate in radically resected pts was 39%, in patients with pN0 28% and in pN1 86%, despite adding CRT. Thirty one patients are alive with 3-year survival 46%. Conclusions: Perioperative chemotherapy ECF/ECCap in our set was feasible and well tolerated. Patients with node positive postoperative stage had poor prognosis, despite completing adjuvant treatment including postoperative CRT. This work was supported by grant NO: IGA MZ(CR) NT/12331-5/2011.