Definitive Chemoradiation for Gastroesophageal junction (GEJ) Adenocarcinomas: A Single-Institution Experience
-
Farshid Farhan
,
Marzieh Lashkari
,
Mohammad Babaei
,
Shiva Mahdavi-seresht
,
Borna Farazmand
,
Ebrahim Esmati
,
Reza Ghalehtaki
Abstract
Background and Objectives: The non-surgical treatment outcome of gastroesophageal junction (GEJ) adenocarcinoma remains to be defined. We aimed to assess the outcomes of definitive chemoradiation (CRT) of GEJ tumors. Methods: In this retrospective cohort, we evaluated 50 patients with non-metastatic adenocarcinoma of GEJ (Siewert's type I and II) treated by chemoradiation without surgery from 2008 to 2017. The reasons for not undergoing surgery were patient refusal, medical unfitness, de novo metastasis in pre-op restaging, and tumor unresectability or progress at the time of operation. The primary outcome was overall survival; secondary outcomes were progression-free survival and local and distal recurrence. Results: The 1-year, 2-year, and 3-year overall survival rates were 53%, 26%, and 12%, respectively. The 1-year, 2-year, and 3-year progression-free survival rates were 44%, 18%, and 10%, respectively. The univariate Cox regression analysis with log-rank test showed that age group and the reason for not undergoing surgery, histologic grade, radiotherapy duration, and distant recurrence had an almost significant association with overall survival. However, after multivariate analysis, the only independent predictor of survival was a distant failure (P=0.031). Conclusion: Although the outcomes of non-surgical treatments are disappointing in GEJ adenocarcinomas, a few patients may experience long-term survival using definitive CRT. This option should be discussed with all patients who are not candidates for surgery.
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11. Kleinberg L, Forastiere AA. Chemoradiation in the management of esophageal cancer. J Clin Oncol. 2007;25(26):4110–7.
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19. Al-Batran SE, Homann N, Schmalenberg H, Kopp HG, Haag GM, Luley KB, Schmiegel WH, Folprecht G, Probst S, Prasnikar N, Thuss-Patience PC. Perioperative chemotherapy with docetaxel, oxaliplatin, and fluorouracil/leucovorin (FLOT) versus epirubicin, cisplatin, and fluorouracil or capecitabine (ECF/ECX) for resectable gastric or gastroesophageal junction (GEJ) adenocarcinoma (FLOT4-AIO): A multicenter, randomized phase 3 trial.
20. Goodman KA, Ou FS, Hall NC, Bekaii-Saab T, Fruth B, Twohy E, Meyers MO, Boffa DJ, Mitchell K, Frankel WL, Niedzwiecki D. Randomized phase II study of pet response–adapted combined modality therapy for esophageal cancer: mature results of the CALGB 80803 (Alliance) trial. Journal of Clinical Oncology. 2021 Sep 1;39(25):2803-15.
21. Shapiro J, Van Lanschot JJ, Hulshof MC, van Hagen P, van Berge Henegouwen MI, Wijnhoven BP, van Laarhoven HW, Nieuwenhuijzen GA, Hospers GA, Bonenkamp JJ, Cuesta MA. Neoadjuvant chemoradiotherapy plus surgery versus surgery alone for oesophageal or junctional cancer (CROSS): long-term results of a randomised controlled trial. The lancet oncology. 2015 Sep 1;16(9):1090-8.
22. Farhan F, Ghalehtaki R, Mahdavi-Seresht S, Meysamie A, Yamrali M, Farazmand B, Mohammadi N, Saraee E, Mir MR, Mir A, Lashkari M. Outcomes of Neoadjuvant Chemoradiation in Patients with Gastro-esophageal Junction Adenocarcinoma: a Retrospective Cohort Study in Iran. Journal of Gastrointestinal Cancer. 2019 Dec;50(4):907-12.
23. Wu AJ, Ilson DH, Janjigian YY, Gerber N, Remis M, Rizk NP, Goodman KA. Definitive Chemoradiation for Adenocarcinoma of the Esophagus and Gastroesophageal Junction. International Journal of Radiation Oncology, Biology, Physics. 2012 Nov 1;84(3):S311.
24. Stahl M, Walz MK, Riera-Knorrenschild J, Stuschke M, Sandermann A, Bitzer M, Wilke H, Budach W. Preoperative chemotherapy versus chemoradiotherapy in locally advanced adenocarcinomas of the oesophagogastric junction (POET): long-term results of a controlled randomised trial. European Journal of Cancer. 2017 Aug 1;81:183-90.
25. Burmeister BH, Thomas JM, Burmeister EA, Walpole ET, Harvey JA, Thomson DB, Barbour AP, Gotley DC, Smithers BM. Is concurrent radiation therapy required in patients receiving preoperative chemotherapy for adenocarcinoma of the oesophagus? A randomised phase II trial. European journal of cancer. 2011 Feb 1;47(3):354-60.
26. Wydmanski J, Grabinska K, Polanowski P, Namysl‑Kaletka A, Kawczynski R, Kraszkiewicz M, Majewski W. Radiotherapy and chemoradiotherapy as a novel option for the treatment of locally advanced inoperable gastric adenocarcinoma: A phase II study. Molecular and Clinical Oncology. 2014 Nov 1;2(6):1150-4.
28. Sun JM, Shen L, Shah MA, Enzinger P, Adenis A, Doi T, Kojima T, Metges JP, Li Z, Kim SB, Cho BC. Pembrolizumab plus chemotherapy versus chemotherapy alone for first-line treatment of advanced oesophageal cancer (KEYNOTE-590): a randomised, placebo-controlled, phase 3 study. The Lancet. 2021 Aug 28;398(10302):759-71.
29. Nomura M, Iwasa S, Tsushima T, Kato K, Yasui H, Boku N, et al. Active salvage chemotherapy versus best supportive care for patients with recurrent or metastatic squamous cell carcinoma of the esophagus refractory or intolerable to fluorouracil, platinum, and taxane. Cancer Chemother Pharmacol. 2016;78(6):1209–16.
2. Deans C, Yeo MSW, Soe MY, Shabbir A, Ti TK, So JBY. Cancer of the gastric cardia is rising in incidence in an Asian population and is associated with adverse outcome. World J Surg. 2011;35(3):617–24.
3. Pohl H, Welch HG. The role of overdiagnosis and reclassification in the marked increase of esophageal adenocarcinoma incidence. J Natl Cancer Inst. 2005;97(2):142–6.
4. Stahl M. Multimodal Therapy of GEJ Cancer: When is the Definitive Radiochemotherapy the Treatment of Choice? In: Recent results in cancer research Fortschritte der Krebsforschung Progres dans les recherches sur le cancer [Internet]. 2012 [cited 2017 Jun 3]. p. 181–5. Available from: http://www.ncbi.nlm.nih.gov/pubmed/23129374
5. Rüdiger SJ, Feith M, Werner M, Stein HJ. Adenocarcinoma of the esophagogastric junction: results of surgical therapy based on anatomical/topographic classification in 1,002 consecutive patients. Ann Surg. 2000;232(3):353–61.
6. Ajani JA, D’Amico TA, Almhanna K, Bentrem DJ, Besh S, Chao J, et al. Esophageal and esophagogastric junction cancers, version 1.2015. J Natl Compr Cancer Netw. 2015;13(2):194–227.
7. Gwynne S, Hurt C, Evans M, Holden C, Vout L, Crosby T. Definitive chemoradiation for oesophageal cancer—a standard of care in patients with non-metastatic oesophageal cancer. Clin Oncol. 2011;23(3):182–8.
8. Tougeron D, Di Fiore F, Hamidou H, Rigal O, Paillot B, Michel P. Response to definitive chemoradiotherapy and survival in patients with an oesophageal adenocarcinoma versus squamous cell carcinoma: a matched-pair analysis. Oncology. 2007;73(5–6):328–34.
9. Welsh J, Settle SH, Amini A, Xiao L, Suzuki A, Hayashi Y, et al. Failure patterns in patients with esophageal cancer treated with definitive chemoradiation. Cancer. 2012;118(10):2632–40.
10. Enzinger PC, Mayer RJ. Esophageal cancer. N Engl J Med. 2003;349(23):2241–52.
11. Kleinberg L, Forastiere AA. Chemoradiation in the management of esophageal cancer. J Clin Oncol. 2007;25(26):4110–7.
12. Stahl M, Stuschke M, Lehmann N, Meyer H-J, Walz MK, Seeber S, et al. Chemoradiation with and without surgery in patients with locally advanced squamous cell carcinoma of the esophagus. J Clin Oncol [Internet]. 2005 Apr 1 [cited 2016 May 5];23(10):2310–7. Available from: http://jco.ascopubs.org/content/23/10/2310.full
13. Bedenne L, Michel P, Bouché O, Milan C, Mariette C, Conroy T, et al. Chemoradiation followed by surgery compared with chemoradiation alone in squamous cancer of the esophagus: FFCD 9102. J Clin Oncol. 2007;25(10):1160–8.
14. Versteijne E, van Laarhoven HWM, van Hooft JE, van Os RM, Geijsen ED, van Berge Henegouwen MI, et al. Definitive chemoradiation for patients with inoperable and/or unresectable esophageal cancer: locoregional recurrence pattern. Dis Esophagus. 2015;28(5):453–9.
15. Tougeron D, Scotte M, Hamidou H, Di Fiore F, Paillot B, Michot F, et al. Definitive chemoradiotherapy in patients with esophageal adenocarcinoma: an alternative to surgery? J Surg Oncol. 2012;105(8):761–6.
16. Shridhar R, Freilich J, Hoffe SE, Almhanna K, Fulp WJ, Yue B, et al. Single-institution retrospective comparison of preoperative versus definitive chemoradiotherapy for adenocarcinoma of the esophagus. Ann Surg Oncol. 2014;21(12):3744–50.
17. Taketa T, Correa AM, Suzuki A, Blum MA, Chien P, Lee JH, et al. Outcome of trimodality-eligible esophagogastric cancer patients who declined surgery after preoperative chemoradiation. Oncology [Internet]. 2012 [cited 2017 Jun 3];83(5):300–4. Available from: http://www.ncbi.nlm.nih.gov/pubmed/22964903
18. Jiang DM, Sim HW, Espin-Garcia O, Chan BA, Natori A, Lim CH, Moignard S, Chen EX, Liu G, Darling G, Swallow CJ. Chemoradiotherapy using carboplatin plus paclitaxel versus cisplatin plus fluorouracil for esophageal or gastroesophageal junction cancer. Oncology. 2021;99(1):49-56.
19. Al-Batran SE, Homann N, Schmalenberg H, Kopp HG, Haag GM, Luley KB, Schmiegel WH, Folprecht G, Probst S, Prasnikar N, Thuss-Patience PC. Perioperative chemotherapy with docetaxel, oxaliplatin, and fluorouracil/leucovorin (FLOT) versus epirubicin, cisplatin, and fluorouracil or capecitabine (ECF/ECX) for resectable gastric or gastroesophageal junction (GEJ) adenocarcinoma (FLOT4-AIO): A multicenter, randomized phase 3 trial.
20. Goodman KA, Ou FS, Hall NC, Bekaii-Saab T, Fruth B, Twohy E, Meyers MO, Boffa DJ, Mitchell K, Frankel WL, Niedzwiecki D. Randomized phase II study of pet response–adapted combined modality therapy for esophageal cancer: mature results of the CALGB 80803 (Alliance) trial. Journal of Clinical Oncology. 2021 Sep 1;39(25):2803-15.
21. Shapiro J, Van Lanschot JJ, Hulshof MC, van Hagen P, van Berge Henegouwen MI, Wijnhoven BP, van Laarhoven HW, Nieuwenhuijzen GA, Hospers GA, Bonenkamp JJ, Cuesta MA. Neoadjuvant chemoradiotherapy plus surgery versus surgery alone for oesophageal or junctional cancer (CROSS): long-term results of a randomised controlled trial. The lancet oncology. 2015 Sep 1;16(9):1090-8.
22. Farhan F, Ghalehtaki R, Mahdavi-Seresht S, Meysamie A, Yamrali M, Farazmand B, Mohammadi N, Saraee E, Mir MR, Mir A, Lashkari M. Outcomes of Neoadjuvant Chemoradiation in Patients with Gastro-esophageal Junction Adenocarcinoma: a Retrospective Cohort Study in Iran. Journal of Gastrointestinal Cancer. 2019 Dec;50(4):907-12.
23. Wu AJ, Ilson DH, Janjigian YY, Gerber N, Remis M, Rizk NP, Goodman KA. Definitive Chemoradiation for Adenocarcinoma of the Esophagus and Gastroesophageal Junction. International Journal of Radiation Oncology, Biology, Physics. 2012 Nov 1;84(3):S311.
24. Stahl M, Walz MK, Riera-Knorrenschild J, Stuschke M, Sandermann A, Bitzer M, Wilke H, Budach W. Preoperative chemotherapy versus chemoradiotherapy in locally advanced adenocarcinomas of the oesophagogastric junction (POET): long-term results of a controlled randomised trial. European Journal of Cancer. 2017 Aug 1;81:183-90.
25. Burmeister BH, Thomas JM, Burmeister EA, Walpole ET, Harvey JA, Thomson DB, Barbour AP, Gotley DC, Smithers BM. Is concurrent radiation therapy required in patients receiving preoperative chemotherapy for adenocarcinoma of the oesophagus? A randomised phase II trial. European journal of cancer. 2011 Feb 1;47(3):354-60.
26. Wydmanski J, Grabinska K, Polanowski P, Namysl‑Kaletka A, Kawczynski R, Kraszkiewicz M, Majewski W. Radiotherapy and chemoradiotherapy as a novel option for the treatment of locally advanced inoperable gastric adenocarcinoma: A phase II study. Molecular and Clinical Oncology. 2014 Nov 1;2(6):1150-4.
28. Sun JM, Shen L, Shah MA, Enzinger P, Adenis A, Doi T, Kojima T, Metges JP, Li Z, Kim SB, Cho BC. Pembrolizumab plus chemotherapy versus chemotherapy alone for first-line treatment of advanced oesophageal cancer (KEYNOTE-590): a randomised, placebo-controlled, phase 3 study. The Lancet. 2021 Aug 28;398(10302):759-71.
29. Nomura M, Iwasa S, Tsushima T, Kato K, Yasui H, Boku N, et al. Active salvage chemotherapy versus best supportive care for patients with recurrent or metastatic squamous cell carcinoma of the esophagus refractory or intolerable to fluorouracil, platinum, and taxane. Cancer Chemother Pharmacol. 2016;78(6):1209–16.
| Files | ||
| Issue | Vol 15 No 2 (2023) | |
| Section | Original Articles | |
| Keywords | ||
| Esophagogastric Junction Adenocarcinoma Esophageal Neoplasms Chemoradiotherapy Survival Rate Gastric Cancer | ||
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How to Cite
1.
Farhan F, Lashkari M, Babaei M, Mahdavi-seresht S, Farazmand B, Esmati E, Ghalehtaki R. Definitive Chemoradiation for Gastroesophageal junction (GEJ) Adenocarcinomas: A Single-Institution Experience. Basic Clin Cancer Res. 2024;15(2):140-150.
