Long-term results of preoperative chemoradiation in clinically resectable gastroesophageal cancer: A single institution experience

Background: The role of preoperative chemoradiotherapy (CRT) in the treatment of adenocarcinomas (AC) of distal esophagus, gastroesophageal junction (GEJ) and stomach is still not clear. The aim of presented study was to evaluate the long-term results of this approach in patients (pts) treated at our institution.

Material and Methods: We retrospectively reviewed the results of preoperative CRT in pts with locally/regionally advanced, but clinically resectable gastroesophageal AC treated with curative intent and prescribed dose of radiotherapy (RT) ≥40 Gy. The therapeutic response was evaluated retrospectively as a percentage of residual tumor cells (RTC: 0%; ≤1%; 2–10%; 11–50%; 51–100%). Overall survival (OS) and disease-free survival (DFS) probability were calculated using the Kaplan–Meier method. The influence of histological subtype and grade, pretreatment and pathological T-stage and N-stage, angioinvasion, perineural invasion and therapeutic response of CRT on OS were analyzed by logrank test, Cox regresion univariate and multivariate analysis.

Results: A total of 108 pts (20 females, 88 males, age 28–80 years, median 62.5 years) underwent preoperative CRT for AC of distal esophagus (24 pts), GEJ (39 pts) or stomach (45 pts) between January 2000 and March 2014. The prescribed dose of RT was 40–50.4 Gy, median 45 Gy. The concurrent chemotherapy was 5-FU (all 108 pts) +/− cDDP (80 pts) +/− taxanes (7 pts). R0 resection was possible in 80 pts (74%), in 3 pts the resection was R1. The tumor was unresectable in 23 pts (mostly for peritoneal dissemination). Two pts did not undergo the surgery. Seventy-nine R0 resected samples were available for the retrospective pathological evaluation. The complete response (0% RTC) was in 20 cases (19%), response ≤1% RTC was in 24 cases (22%), 1–10% in 16 cases (15%), 11–50% in 8 cases (7%) and no response (51–100%) was in 11 cases (10%). The median follow-up of surviving patients was 50.8 months (7–165 months). 3-y and 5-y OS was 36.2% and 25.3%, resp., and 3-y and 5-y DFS was 37.2% and 31.4%, resp. Pretreatment T-stage, pathological N-stage, histological subtype, angioinvasion and perineural invasion were identified as statistical significant OS predictors. The primary tumor location did not influence the prognosis. The CRT treatment response (RTC ≤1% vs >1%) had borderline significance (p=0.08).

Conclusion: Preoperative CRT in gastroesophageal AC is associated with a high number of significant responses. The effect of this approach on OS has to be evaluated in a phase III trial.

No conflict of interest.