M Orditura1, G Galizia2, N Di Martino2, E Ancona3, C Castoro3, R Pacelli4, F Morgillo1, S Rossetti1, V Gambardella1, A Farella4, M M Laterza1, A Ruol3, A Fabozzi1, V Napolitano2, F Iovino2, E Lieto2, L Fei2, G Conzo2, F Ciardiello1, F De Vita1. 1. Division of Medical Oncology, Department of Clinical and Experimental Medicine and Surgery, Second University of Naples School of Medicine, Naples, Italy. 2. Divisions of Surgical Oncology, Department of Anesthesiologic, Surgical, and Emergency Sciences, Second University of Naples School of Medicine, Naples, Italy. 3. Division of General Surgery 1, University of Padua, School of Medicine, Padua, Italy. 4. Division of Radiotherapy, Federico ii University of Naples School of Medicine, Naples, Italy.
Abstract
BACKGROUND: To date, few studies of preoperative chemotherapy or chemoradiotherapy (crt) in gastroesophageal junction (gej) cancer have been statistically powered; indeed, gej tumours have thus far been grouped with esophageal or gastric cancer in phase iii trials, thereby generating conflicting results. METHODS: We studied 41 patients affected by locally advanced Siewert type i and ii gej adenocarcinoma who were treated with a neoadjuvant crt regimen [folfox4 (leucovorin-5-fluorouracil-oxaliplatin) for 4 cycles, and concurrent computed tomography-based three-dimensional conformal radiotherapy delivered using 5 daily fractions of 1.8 Gy per week for a total dose of 45 Gy], followed by surgery. Completeness of tumour resection (performed approximately 6 weeks after completion of crt), clinical and pathologic response rates, and safety and outcome of the treatment were the main endpoints of the study. RESULTS: All 41 patients completed preoperative treatment. Combined therapy was well tolerated, with no treatment-related deaths. Dose reduction was necessary in 8 patients (19.5%). After crt, 78% of the patients showed a partial clinical response, 17% were stable, and 5% experienced disease progression. Pathology examination of surgical specimens demonstrated a 10% complete response rate. The median and mean survival times were 26 and 36 months respectively (95% confidence interval: 14 to 37 months and 30 to 41 months respectively). On multivariate analysis, TNM staging and clinical response were demonstrated to be the only independent variables related to long-term survival. CONCLUSIONS: In our experience, preoperative chemoradiotherapy with folfox4 is feasible in locally advanced gej adenocarcinoma, but shows mild efficacy, as suggested by the low rate of pathologic complete response.
BACKGROUND: To date, few studies of preoperative chemotherapy or chemoradiotherapy (crt) in gastroesophageal junction (gej) cancer have been statistically powered; indeed, gej tumours have thus far been grouped with esophageal or gastric cancer in phase iii trials, thereby generating conflicting results. METHODS: We studied 41 patients affected by locally advanced Siewert type i and ii gej adenocarcinoma who were treated with a neoadjuvant crt regimen [folfox4 (leucovorin-5-fluorouracil-oxaliplatin) for 4 cycles, and concurrent computed tomography-based three-dimensional conformal radiotherapy delivered using 5 daily fractions of 1.8 Gy per week for a total dose of 45 Gy], followed by surgery. Completeness of tumour resection (performed approximately 6 weeks after completion of crt), clinical and pathologic response rates, and safety and outcome of the treatment were the main endpoints of the study. RESULTS: All 41 patients completed preoperative treatment. Combined therapy was well tolerated, with no treatment-related deaths. Dose reduction was necessary in 8 patients (19.5%). After crt, 78% of the patients showed a partial clinical response, 17% were stable, and 5% experienced disease progression. Pathology examination of surgical specimens demonstrated a 10% complete response rate. The median and mean survival times were 26 and 36 months respectively (95% confidence interval: 14 to 37 months and 30 to 41 months respectively). On multivariate analysis, TNM staging and clinical response were demonstrated to be the only independent variables related to long-term survival. CONCLUSIONS: In our experience, preoperative chemoradiotherapy with folfox4 is feasible in locally advanced gej adenocarcinoma, but shows mild efficacy, as suggested by the low rate of pathologic complete response.
Entities:
Keywords:
Preoperative chemoradiotherapy; folfox4; gastroesophageal junction cancer
Authors: Michele Orditura; Gennaro Galizia; Vincenzo Napolitano; Erika Martinelli; Roberto Pacelli; Eva Lieto; Gaetano Aurilio; Loredana Vecchione; Floriana Morgillo; Giuseppe Catalano; Fortunato Ciardiello; Alberto Del Genio; Natale Di Martino; Ferdinando De Vita Journal: Cancer Invest Date: 2010-10 Impact factor: 2.176
Authors: F Fiorica; D Di Bona; F Schepis; A Licata; L Shahied; A Venturi; A M Falchi; A Craxì; C Cammà Journal: Gut Date: 2004-07 Impact factor: 23.059
Authors: Kun Yang; Hai-Ning Chen; Xin-Zu Chen; Qing-Chun Lu; Lin Pan; Jie Liu; Bin Dai; Bo Zhang; Zhi-Xin Chen; Jia-Ping Chen; Jian-Kun Hu Journal: PLoS One Date: 2012-06-04 Impact factor: 3.240
Authors: Milan Vošmik; Jan Laco; Igor Sirák; Josef Dvořák; Petr Lochman; Miroslav Hodek; Petra Malá; Stanislav Rejchrt; Rudolf Repák; Michal Leško; Alexander Ferko; Aleš Ryška; Bohuslav Melichar; Jiří Petera Journal: Pathol Oncol Res Date: 2017-05-27 Impact factor: 3.201
Authors: Ayesha Noorani; Jan Bornschein; Andy G Lynch; Maria Secrier; Achilleas Achilleos; Matthew Eldridge; Lawrence Bower; Jamie M J Weaver; Jason Crawte; Chin-Ann Ong; Nicholas Shannon; Shona MacRae; Nicola Grehan; Barbara Nutzinger; Maria O'Donovan; Richard Hardwick; Simon Tavaré; Rebecca C Fitzgerald Journal: Genome Res Date: 2017-05-02 Impact factor: 9.043