Survival analysis of preoperative involved-field irradiation with concurrent chemotherapy for patients with Siewert′s type II and III adenocarcinoma of esophagogastric junction

Abstract

Objective To analyze the clinical efficacy, toxicity and survival prognosis of patients diagnosed with Siewert type Ⅱ and Ⅲ locally advanced adenocarcinoma of esophagogastric junction (AEG) undergoing preoperative involved-field irradiation with concurrent chemotherapy. Methods A total of 45 cases were recruited in this prospective clinical trial. Prior to surgery, patients received 2 cycles of chemotherapy with XELOX and concurrent radiotherapy (a total of 45 Gy in 25 fractions, 5 times weekly). After 6-8 weeks, they underwent surgical resection. After the surgery, patients received 6 cycles of adjuvant chemotherapy. The completion of preoperative neoadjuvant chemoradiotherapy, postoperative pathological status, TNM down-staging effect and adverse reactions were observed. Kaplan-Meier method was applied to estimate survival analysis. Results All 45 patients completed preoperative neoadjuvant chemoradiotherapy. Among them, 39 patients completed 2 cycles of chemotherapy, and 6 patients completed 1 cycle of chemotherapy. The median time of surgical interval was 6 weeks. The R0 resection rate was 96%.The pathological complete response (pCR) rate was 22%. The TNM down-staging rate was 69%.The incidence of acute radiation-induced esophagitis or gastritis was 44% and the incidence of radiation-induced pneumonitis was 7%. The incidence of grade 1-3 leukocytopenia, thrombocytopenia and neutropenia was 78%, 47% and 44%, respectively. In terms of gastrointestinal reactions, the incidence of nausea, vomiting and loss of appetite was 62%, 24% and 71%, respectively. No hematologic or nonhematologic adverse effects was observed at grade 4 or 5.The median follow-up time was 30 months. 11 patients died of cancer, 1 patient was treatment-related death in the perioperative period and 1 patient died of pneumonia. The 1-, 2-and 3-year progression-free survival (PFS) rates were 90%, 70% and 67%, respectively. The 1-, 2-and 3-year overall survival rates were 95%, 80% and 75%, respectively. The 1-, 2-and 3-year local control rates were 95%, 84% and 84%, respectively. The 1-, 2-and 3-year distant metastasis rates were 7%, 25% and 25%, respectively. Conclusions Preoperative involved-field irradiation with concurrent chemotherapy yields relatively high clinical efficacy and is well tolerated by patients with Siewert type Ⅱ and Ⅲ locally advanced AEG.Patients are recommended to receive 4 cycles of adjuvant chemotherapy following neoadjuvant chemoradiotherapy and surgery. Key words: Adenocarcinoma of esophagogastric junction/radiotherapy; Adenocarcinoma of esophagogastric junction/chemotherapy; Prognosis; Drug tolerance