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Journal of Gastrointestinal Cancer

, Volume 50, Issue 4, pp 907–912 | Cite as

Outcomes of Neoadjuvant Chemoradiation in Patients with Gastro-esophageal Junction Adenocarcinoma: a Retrospective Cohort Study in Iran

  • Farshid Farhan
  • Reza Ghalehtaki
  • Shiva Mahdavi-Seresht
  • Alipasha Meysamie
  • Maisa Yamrali
  • Borna Farazmand
  • Negin Mohammadi
  • Ehsan Saraee
  • Mohammad-Reza Mir
  • Ali Mir
  • Marzieh LashkariEmail author
  • Samaneh Salarvand
  • Ebrahim Esmati
  • Farhad Samiei
Original Research
  • 39 Downloads

Abstract

Purpose

The optimal treatment for locally advanced GEJ and cardia adenocarcinoma is controversial. Several studies have shown that treating these patients with neoadjuvant chemoradiotherapy followed by surgery leads to survival benefits, and there are also studies that have declared conflicting results. It seems that there is still room for discussion. We calculated the survival rates and pathologic responses in our patients with characteristics which we mentioned above.

Methods

Patients with locally advanced, non-metastatic GEJ and cardia adenocarcinomas (only patients with Siewert’s type I and II), who were referred to Imam Khomeini hospital (Institute of cancer) between 2005 and 2014 and received neoadjuvant chemoradiation and underwent surgery were enrolled in this retrospective cohort study. Evaluations were done every 3 months.

Results

Thirty-two patients enrolled in this study. Median follow up time was 23 months (Reverse Kaplan-Meier method). The rates of 1-year survival, 2-year survival, 3-year survival, 4-year survival, and 5-year survival were 75%, 52%, 52%, 37%, and 37%, respectively. No local recurrences occurred among patients; however, four patients experienced distal recurrence in the following locations: two cases (6.3%) in the liver, one case (3.1%) in the lung, and one case (3.1%) in the peritoneum. The rate of complete pathologic response (T0N0) was 21.9%.

Conclusions

Neoadjuvant chemoradiation in patients with locally advanced GEJ and cardia adenocarcinoma will lead to a survival benefit.

Keywords

Chemoradiotherapy Esophageal neoplasms Gastrointestinal cancer Iran Neoadjuvant 

Notes

Compliance with Ethical Standards

Conflict of Interest

The authors declare that they have no conflict of interest.

References

  1. 1.
    Jemal A, Siegel R, Xu J, Ward E. Cancer statistics, 2010. CA Cancer J Clin. 2010;60(5):277–300.CrossRefGoogle Scholar
  2. 2.
    Kamangar F, Dores GM, Anderson WF. Patterns of cancer incidence, mortality, and prevalence across five continents: defining priorities to reduce cancer disparities in different geographic regions of the world. J Clin Oncol. 2006 May;24(14):2137–50.  https://doi.org/10.1200/JCO.2005.05.2308.CrossRefPubMedGoogle Scholar
  3. 3.
    Aledavood A, Anvari K, Sabouri G. Esophageal cancer in northeast of Iran. Iran J Cancer Prev. 2011;4(3):125–9.PubMedPubMedCentralGoogle Scholar
  4. 4.
    Babaei M, Pourfarzi F, Yazdanbod A, Chiniforush MM, Derakhshan MH, Mousavi SM, et al. Gastric cancer in Ardabil, Iran--a review and update on cancer registry data. Asian Pac J Cancer Prev. 2010;11(3):595–9. Available from: http://www.ncbi.nlm.nih.gov/pubmed/21039022 PubMedGoogle Scholar
  5. 5.
    Siewert JR, Stein HJ. Carcinoma of the gastroesophageal junction - classification, pathology and extent of resection. Dis Esophagus. 1996;9(3):173–82.  https://doi.org/10.1093/dote/9.3.173.CrossRefGoogle Scholar
  6. 6.
    Iyer R, Wilkinson N, Demmy T, Javle M. Controversies in the multimodality management of locally advanced esophageal cancer: evidence-based review of surgery alone and combined-modality therapy. Ann Surg Oncol. 2004;11(7):665–73.CrossRefGoogle Scholar
  7. 7.
    Sjoquist KM, Burmeister BH, Smithers BM, Zalcberg JR, Simes RJ, Barbour A, et al. Survival after neoadjuvant chemotherapy or chemoradiotherapy for resectable oesophageal carcinoma: an updated meta-analysis. Lancet Oncol. 2011;12(7):681–92.  https://doi.org/10.1016/S1470-2045(11)70142-5.CrossRefGoogle Scholar
  8. 8.
    Urschel JD, Vasan H. A meta-analysis of randomized controlled trials that compared neoadjuvant chemoradiation and surgery to surgery alone for resectable esophageal cancer. Am J Surg. 2003;185(6):538–43.CrossRefGoogle Scholar
  9. 9.
    van Hagen P, Hulshof MCCM, van Lanschot JJB, Steyerberg EW, van Berge Henegouwen MI, BPL W, et al. Preoperative chemoradiotherapy for esophageal or junctional cancer. N Engl J Med. 2012;366(22):2074–84.  https://doi.org/10.1056/NEJMoa1112088.CrossRefGoogle Scholar
  10. 10.
    Mariette C, Dahan L, Mornex F, Maillard E, Thomas PA, Meunier B, et al. Surgery alone versus chemoradiotherapy followed by surgery for stage I and II esophageal cancer: final analysis of randomized controlled phase III trial FFCD 9901. J Clin Oncol. 2014;32(23):2416–22.CrossRefGoogle Scholar
  11. 11.
    Ajani JA, Mansfield PF, Janjan N, Morris J, Pisters PW, Lynch PM, et al. Multi-institutional trial of preoperative chemoradiotherapy in patients with potentially resectable gastric carcinoma. J Clin Oncol. 2004;22(14):2774–80.CrossRefGoogle Scholar
  12. 12.
    Ajani JA, Mansfield PF, Crane CH, Wu TT, Lunagomez S, Lynch PM, et al. Paclitaxel-based chemoradiotherapy in localized gastric carcinoma: degree of pathologic response and not clinical parameters dictated patient outcome. J Clin Oncol. 2005;23(6):1237–44.CrossRefGoogle Scholar
  13. 13.
    Ajani JA, Winter K, Okawara GS, Donohue JH, Pisters PWT, Crane CH, et al. Phase II trial of preoperative chemoradiation in patients with localized gastric adenocarcinoma (RTOG 9904): quality of combined modality therapy and pathologic response. J Clin Oncol. 2006;24(24):3953–8.CrossRefGoogle Scholar
  14. 14.
    Motoori M, Yano M, Yasuda T, Miyata H, Peng Y, Yamasaki M, et al. Early response to neoadjuvant chemotherapy in advanced esophageal cancer evaluated by computed tomography predicts the utility of a second cycle of chemotherapy. Mol Clin Oncol. 2013;1(3):521–6. Available from: http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=3916104&tool=pmcentrez&rendertype=abstract CrossRefGoogle Scholar
  15. 15.
    Zhou Z, Nimeiri HS, Benson AB. Preoperative chemotherapy for locally advanced resectable colon cancer - a new treatment paradigm in colon cancer? Ann Transl Med. 2013;1(2):11–6. Available from: http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=4200631&tool=pmcentrez&rendertype=abstract PubMedPubMedCentralGoogle Scholar
  16. 16.
    Group MRCOCW. Surgical resection with or without preoperative chemotherapy in oesophageal cancer: a randomised controlled trial. Lancet. 2002;359(9319):1727–33. Available from: http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=12049861 CrossRefGoogle Scholar
  17. 17.
    Stahl M, Walz MK, Stuschke M, Lehmann N, Meyer HJ, Riera-Knorrenschild J, et al. Phase III comparison of preoperative chemotherapy compared with chemoradiotherapy in patients with locally advanced adenocarcinoma of the esophagogastric junction. J Clin Oncol. 2009;27(6):851–6.CrossRefGoogle Scholar
  18. 18.
    Walsh T et al. A comparison of multimodal therapy and surgery for esophageal adenocarcinoma. 1996;Google Scholar
  19. 19.
    Urba SG, Orringer MB, Turrisi A, Iannettoni M, Forastiere A, Strawderman M. Randomized trial of preoperative chemoradiation versus surgery alone in patients with locoregional esophageal carcinoma. J Clin Oncol. 2001 Jan;19(2):305–13.CrossRefGoogle Scholar
  20. 20.
    Burmeister B, Smithers M, Gebski V, Denham J, Devitt P, Ackland S, et al. Surgery alone versus chemoradiotherapy followed by surgery for resectable cancer of the oesophagus: a randomised controlled phase III trial. Lancet Oncol. 2005;6(9):659–68.CrossRefGoogle Scholar
  21. 21.
    Akhavan A, Binesh F, Seifaddiny A. Characteristics and survival rate of patients with gastric and gastroesophageal junction adenocarcinoma in Yazd, Iran. 2013;4(3):125–9.Google Scholar
  22. 22.
    Anvari K, Aledavood SA, Toussi MS, Forghani MN, Mohtashami S, Rajabi MT, et al. A clinical trial of neoadjuvant concurrent chemoradiotherapy followed by resection for esophageal carcinoma. J Res Med Sci. 2015 Aug;20(8):751–6.CrossRefGoogle Scholar
  23. 23.
    Cellini F, Fiore M, Mattiucci G. Gastrointestinal & digestive system radiochemotherapy in the management of gastroesophageal junction tumours: basic evidences in the neoadjuvant setting. 2013;3(4):3–6.Google Scholar
  24. 24.
    Tepper J, Krasna MJ, Niedzwiecki D, Hollis D, Reed CE, Goldberg R, et al. Phase III trial of trimodality therapy with cisplatin, fluorouracil, radiotherapy, and surgery compared with surgery alone for esophageal cancer: CALGB 9781. J Clin Oncol. 2008 Mar;26(7):1086–92.CrossRefGoogle Scholar
  25. 25.
    Ychou M, Boige V, Pignon JP, Conroy T, Bouché O, Lebreton G, et al. Perioperative chemotherapy compared with surgery alone for resectable gastroesophageal adenocarcinoma: an FNCLCC and FFCD multicenter phase III trial. J Clin Oncol. 2011;29(13):1715–21.CrossRefGoogle Scholar
  26. 26.
    Soon YY, Leong CN, Tey JCS, Tham IWK, Lu JJ. Postoperative chemo-radiotherapy versus chemotherapy for resected gastric cancer: a systematic review and meta-analysis. J Med Imaging Radiat Oncol. 2014;58(4):483–96.PubMedGoogle Scholar
  27. 27.
    Sun L, Zhao G, Ding D, Song B, Hou R, Li Y. Comparison between better and poorly differentiated locally advanced gastric cancer in preoperative chemotherapy: a retrospective , comparative study at a single tertiary care institute. 2014;1–5.Google Scholar
  28. 28.
    Mirza A, Pritchard S, Welch I. The postoperative component of MAGIC chemotherapy is associated with improved prognosis following surgical resection in gastric and gastrooesophageal junction adenocarcinomas. Int J Surg Oncol. 2013;2013Google Scholar
  29. 29.
    Li LL, Xie CY, Su HF. Benefit of radiotherapy on survival in resectable gastric carcinoma: a meta-analysis. Tumor Biol. 2014;35(5):4957–66.CrossRefGoogle Scholar
  30. 30.
    Zhai YJ, Su YP, Wang SJ, Ning FL, Wang ZB, Yu WZ, et al. A phase II trial of post-operative chemoradiotherapy for completely resected gastric cancer with D2 lymphadenectomy. Oncol Lett. 2014;8(4):1844–8.CrossRefGoogle Scholar
  31. 31.
    Cunningham D, Allum WH, Stenning SP, Thompson JN, Van de Velde CJH, Nicolson M, et al. Perioperative chemotherapy versus surgery alone for resectable gastroesophageal cancer. N Engl J Med. 2006;355(1):11–20.  https://doi.org/10.1056/NEJMoa055531.CrossRefGoogle Scholar
  32. 32.
    Boige V, Pignon J, Saint-Aubert B, Lasser P, Conroy T, Bouché O, et al. Final results of a randomized trial comparing preoperative 5-fluorouracil (F)/cisplatin (P) to surgery alone in adenocarcinoma of stomach and lower esophagus (ASLE): FNLCC ACCORD07-FFCD 9703 trial. J Clin Oncol. 2007;25(18_suppl):4510.  https://doi.org/10.1200/jco.2007.25.18_suppl.4510.CrossRefGoogle Scholar
  33. 33.
    Thirion PG, Michiels S, Le Maître A, Tierney J. Individual patient data-based meta-analysis assessing pre-operative chemotherapy in resectable oesophageal carcinoma. J Clin Oncol. 2007;25(18_suppl):4512.  https://doi.org/10.1200/jco.2007.25.18_suppl.4512.CrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2018

Authors and Affiliations

  • Farshid Farhan
    • 1
  • Reza Ghalehtaki
    • 1
  • Shiva Mahdavi-Seresht
    • 1
  • Alipasha Meysamie
    • 2
  • Maisa Yamrali
    • 1
  • Borna Farazmand
    • 1
  • Negin Mohammadi
    • 1
  • Ehsan Saraee
    • 1
  • Mohammad-Reza Mir
    • 3
  • Ali Mir
    • 3
  • Marzieh Lashkari
    • 4
    Email author
  • Samaneh Salarvand
    • 5
  • Ebrahim Esmati
    • 1
  • Farhad Samiei
    • 1
  1. 1.Department of Radiation Oncology, Cancer InstituteTehran University of Medical SciencesTehranIran
  2. 2.Department of Community Medicine, School of MedicineTehran University of Medical SciencesTehranIran
  3. 3.Department of Surgical Oncology, Cancer InstituteTehran University of Medical SciencesTehranIran
  4. 4.Radiation Oncology Research Center (RORC), Cancer InstituteTehran University of Medical SciencesTehranIran
  5. 5.Department of Anatomical and Clinical Pathology, Cancer InstituteTehran University of Medical SciencesTehranIran

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