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

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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.

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References

  1. Jemal A, Siegel R, Xu J, Ward E. Cancer statistics, 2010. CA Cancer J Clin. 2010;60(5):277–300.

    Article  Google Scholar 

  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.

    Article  PubMed  Google Scholar 

  3. Aledavood A, Anvari K, Sabouri G. Esophageal cancer in northeast of Iran. Iran J Cancer Prev. 2011;4(3):125–9.

    CAS  PubMed  PubMed Central  Google Scholar 

  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

    PubMed  Google Scholar 

  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.

    Article  Google Scholar 

  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.

    Article  CAS  Google Scholar 

  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.

    Article  Google Scholar 

  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.

    Article  Google Scholar 

  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.

    Article  Google Scholar 

  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.

    Article  CAS  Google Scholar 

  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.

    Article  CAS  Google Scholar 

  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.

    Article  CAS  Google Scholar 

  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.

    Article  CAS  Google Scholar 

  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

    Article  CAS  Google Scholar 

  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

    PubMed  PubMed Central  Google Scholar 

  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

    Article  Google Scholar 

  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.

    Article  CAS  Google Scholar 

  18. Walsh T et al. A comparison of multimodal therapy and surgery for esophageal adenocarcinoma. 1996;

  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.

    Article  CAS  Google Scholar 

  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.

    Article  Google Scholar 

  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.

  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.

    Article  CAS  Google Scholar 

  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.

  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.

    Article  CAS  Google Scholar 

  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.

    Article  CAS  Google Scholar 

  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.

    PubMed  Google Scholar 

  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.

  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;2013

  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.

    Article  Google Scholar 

  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.

    Article  Google Scholar 

  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.

    Article  CAS  Google Scholar 

  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.

    Article  Google Scholar 

  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.

    Article  Google Scholar 

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Authors and Affiliations

  1. Department of Radiation Oncology, Cancer Institute, Tehran University of Medical Sciences, Tehran, Iran

    Farshid Farhan, Reza Ghalehtaki, Shiva Mahdavi-Seresht, Maisa Yamrali, Borna Farazmand, Negin Mohammadi, Ehsan Saraee, Ebrahim Esmati & Farhad Samiei

  2. Department of Community Medicine, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran

    Alipasha Meysamie

  3. Department of Surgical Oncology, Cancer Institute, Tehran University of Medical Sciences, Tehran, Iran

    Mohammad-Reza Mir & Ali Mir

  4. Radiation Oncology Research Center (RORC), Cancer Institute, Tehran University of Medical Sciences, Keshavarz Blvd., Tehran, Iran

    Marzieh Lashkari

  5. Department of Anatomical and Clinical Pathology, Cancer Institute, Tehran University of Medical Sciences, Tehran, Iran

    Samaneh Salarvand

Authors
  1. Farshid Farhan
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  2. Reza Ghalehtaki
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Correspondence to Marzieh Lashkari.

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Farhan, F., Ghalehtaki, R., Mahdavi-Seresht, S. et al. Outcomes of Neoadjuvant Chemoradiation in Patients with Gastro-esophageal Junction Adenocarcinoma: a Retrospective Cohort Study in Iran. J Gastrointest Canc 50, 907–912 (2019). https://doi.org/10.1007/s12029-018-0155-7

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  • DOI: https://doi.org/10.1007/s12029-018-0155-7

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