Concurrent Neoadjuvant Chemoradiotherapy for Siewert II and III Adenocarcinoma at Gastroesophageal Junction

Published on Jun 1, 2015in The American Journal of the Medical Sciences2.378
· DOI :10.1097/MAJ.0000000000000476
J. Zhang1
Estimated H-index: 1
(Hebei Medical University)
Sources
Abstract
Abstract Objective This study was conducted to investigate the efficacy and safety of using a concurrent neoadjuvant chemoradiotherapy (a XELOX regimen) to treat adenocarcinoma of the gastroesophageal junction. Methods Seventy-six patients having resectable adenocarcinoma at the gastroesophageal junction (T3/4, N+, M0) were recruited to participate and randomly assigned to either a chemoradiotherapy group or a surgery group. Patients in the chemoradiotherapy group were orally given capecitabine (1,000mg/m 2 , twice daily for 14 days, days 1–14) and intravenous oxaliplatin (130mg/m 2 on day 1) for 2 cycles. Radiotherapy was performed with a total of 45Gy administered in 25 sessions for 5 weeks. Patients in the surgery group received only surgical intervention. Results In the concurrent chemoradiotherapy group, the overall response rate was 55.6% (20/36), tumor control rate was 100% and a pathological complete response was achieved in 16.7% (6/36). The entire chemoradiotherapy group had R0 resections as did 80% of the surgery group (32/40) ( P Conclusions Concurrent neoadjuvant chemoradiotherapy administration increased the rate of R0 resection and demonstrated favorable safety in patients with siewert ii or iii adenocarcinoma at the gastroesophageal junction. These results support the use of neoadjunctive chemoradiotherapy in the treatment of adenocarcinoma of the gastroesophageal junction.
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#2Alessio G. Morganti (UCSC: Catholic University of the Sacred Heart)H-Index: 35
Last. Vincenzo Valentini (UCSC: Catholic University of the Sacred Heart)H-Index: 68
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Gastroesophageal cancers (such as esophageal, gastric and gastroesophageal-junction -GEJ- lesions) are worldwide a leading cause of death being relatively rare but highly aggressive. In the past years, a clear shift in the location of upper gastrointestinal tract tumors has been recorded, both affecting the scientific research and the modern clinical practice. The integration of pre- or peri-operative multimodal approaches, as radiotherapy and chemotherapy (often combined), seems promising to fu...
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#1Takaki Yoshikawa (Kanagawa Prefectural Hospital)H-Index: 55
#2Kazuaki Tanabe (Hiroshima University)H-Index: 30
Last. Junichi Sakamoto (Nagoya University)H-Index: 56
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Background The prognosis for stage 3 gastric cancer is not satisfactory, even with S-1 adjuvant chemotherapy. A randomized phase II trial was conducted to compare two and four courses of neoadjuvant S-1/cisplatin (SC) and paclitaxel/cisplatin (PC) using a two-by-two factorial design for locally advanced gastric cancer. The primary endpoint was overall survival. We clarified the impact of these regimens on the secondary endpoints, including the clinical and pathological responses, chemotherapy-re...
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#1Ulrich Ronellenfitsch (Heidelberg University)H-Index: 23
Last. Katrin Jensen (Heidelberg University)H-Index: 24
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Background The prognosis of patients with gastroesophageal adenocarcinoma is poor. There is conflicting evidence regarding effects of preoperative chemotherapy on survival and other outcomes. Methods We conducted a meta-analysis with aggregate and individual patient data (IPD) to assess the effect of preoperative chemotherapy for gastroesophageal adenocarcinoma on survival and other outcomes. Two independent reviewers identified eligible randomised controlled trials (RCTs) comparing chemotherapy...
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#1Lee W. Jones (Duke University)H-Index: 96
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Aerobic exercise training (AET) is an effective adjunct therapy to attenuate the adverse side-effects of adjuvant chemotherapy in women with early breast cancer. Whether AET interacts with the antitumor efficacy of chemotherapy has received scant attention. We carried out a pilot study to explore the effects of AET in combination with neoadjuvant doxorubicin–cyclophosphamide (AC+AET), relative to AC alone, on: (i) host physiology [exercise capacity (VO2 peak), brachial artery flow-mediated dilat...
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Last. Yuichiro DokiH-Index: 93
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Esophagogastric junction (EGJ) adenocarcinomas are usually classified into one of the three categories of the Siewert system. The clinicopathological features of EGJ adenocarcinomas vary according to this classification scheme. The lymphatic flow in EGJ tumors of any type is mainly toward the abdomen, and nodal metastasis to the upper or middle mediastinum from Siewert type II or III tumors is relatively uncommon. Thus, the transhiatal approach is regarded as the standard in surgery for Siewert ...
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Last. Sung Hoon Noh (Yonsei University)H-Index: 73
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response. The 1-, 2-, and 3-year disease-free survivals were 83.4%, 70%, and 52.2%. The 1-, 3-, 5-year overall survivals were 88.5%, 67.5%, and 51.2%, respectively. Although a complete pathologic response (ypT0N0M0) was achieved in 7 patients, 28.6% of them demonstrated recurrence of the tumor within 6 months after curative surgery. Conclusion: CCRTx rather than CTx appears to be more effective for achieving good pathologic response. Although favorable pathologic response has been achieved after...
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#1Michele Iester (UniGe: University of Genoa)H-Index: 30
#2Serena Telani (UniGe: University of Genoa)H-Index: 5
Last. Daniela PaoliH-Index: 1
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Abstract Purpose: Supposedly, prostaglandin analogs (PGA) could reduce the central corneal thickness (CCT), while topical carbonic anhydrase inhibitors (TCAI) could increase CCT. The aim of the study was to evaluate clinically significant CCT effects in patients treated with PGA or TCAI. Methods: At least 50 glaucomatous patients were saved on the Italian Glaucoma Register from 16 different glaucoma centers. About 816 glaucomatous patients were found in the register; of these, 316 were recruited...
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#2Harvey J. Mamon (Brigham and Women's Hospital)H-Index: 37
Last. Peter C. Enzinger (Harvard University)H-Index: 53
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Purpose. To determine the efficacy and toxicity of weekly neoadjuvant cetuximab combined with irinotecan, cisplatin, and radiation therapy in patients with locally advanced esophageal or gastroesophageal junction cancer.
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Last. Heinz Schmidberger (University of Mainz)H-Index: 35
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Background This phase I/II-trial assessed the dose-limiting toxicities (DLT) and maximum tolerated dose (MTD) of neoadjuvant radiochemotherapy (RCT) with docetaxel and oxaliplatin in patients with locally advanced adenocarcinoma of the oesophagogastric junction.
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#2Junzo Chino (Duke University)H-Index: 22
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To examine toxicity and outcomes for patients treated with preoperative chemoradiotherapy (CRT) for gastric cancer. Patients with gastroesophageal (GE) junction (Siewert type II and III) or gastric adenocarcinoma who underwent neoadjuvant CRT followed by planned surgical resection at Duke University between 1987 and 2009 were reviewed. Overall survival (OS), local control (LC) and disease-free survival (DFS) were estimated using the Kaplan-Meier method. Toxicity was graded according to the Commo...
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Cited By9
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#1Yuan TianH-Index: 6
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#1Jing Li (Hebei Medical University)H-Index: 3
#2Qun Zhao (Hebei Medical University)H-Index: 13
Last. Ming Liu (Hebei Medical University)H-Index: 1
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BACKGROUND To analyze whether neoadjuvant chemoradiotherapy (nCRT) could improve the survival for patients with adenocarcinoma of the esophagogastric junction compared with neoadjuvant chemotherapy (nCT). Both neoadjuvant chemotherapy alone and chemoradiotherapy before surgery have been shown to improve overall long-term survival for patients with adenocarcinoma in the esophagus or esophagogastric junction compared to surgery alone. It remains controversial whether nCRT is superior to nCT. METHO...
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This study aimed to investigate the efficacy and safety of concurrent neoadjuvant chemoradiotherapy (CRT) plus apatinib in treating locally advanced, HER2-negative, Siewert's type II-III adenocarcinoma of esophagogastric junction (AEG) patients. Thirty eligible patients were analyzed in this single-arm, open-label, phase II trial. Patients received neoadjuvant regimen as follows: two cycles of apatinib (orally, 250 mg/day on day 1-28), two cycles of capecitabine (orally, 1,000 mg/m2 twice daily ...
ABSTRACT Purpose Limited guidance exists regarding the relative effectiveness of treatment options for non-metastatic, operable patients with adenocarcinoma of the esophagus or gastroesophageal junction (GEJ). In this systematic review, the American Radium Society (ARS) gastrointestinal expert panel convened to develop Appropriate Use Criteria (AUC) evaluating how neoadjuvant and/or adjuvant treatment regimens compared to each other, surgery alone, or definitive chemoradiation in terms of respon...
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#1Manish A. Shah (Cornell University)H-Index: 74
#2Erin B. Kennedy (American Society of Clinical Oncology)H-Index: 20
Last. Wayne L. Hofstetter (University of Texas MD Anderson Cancer Center)H-Index: 77
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PURPOSETo develop an evidence-based clinical practice guideline to assist in clinical decision making for patients with locally advanced esophageal cancer.METHODSASCO convened an Expert Panel to co...
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#1Steven EngelH-Index: 2
#2Adam Awerbuch (UM: University of Miami)H-Index: 3
Last. Lorraine PortelanceH-Index: 22
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Background: This is the first meta-analysis to study optimal radiation dose in the setting of concurrent neoadjuvant chemoradiotherapy (cnCRT) for esophageal cancer (EC). We sought to compare outcomes between high dose radiotherapy (HDRT) [>48.85 Gy biologically effective dose (BED)] group and low dose radiotherapy (LDRT) (≤48.85 Gy BED) for patients with EC receiving cnCRT. Methods: Medline, Embase, and Cochrane databases were searched independently by two members of our team on August 07, 2017...
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#3Yan Zhao (PRC: China Medical University (PRC))H-Index: 8
Background: Neoadjuvant chemoradiation (CRT) remains controversial in the treatment of the oesophagus or gastro-oesophageal junction (GOJ) carcinomas. Methods: We conducted a meta-analysis to assess the efficacy and safety of Neoadjuvant CRT plus surgery comparing with neoadjuvant CT plus surgery or surgery alone. Feasible studies were searched from electronic databases. The outcomes of survival, R0 resection rate and adverse effects were analyzed. The outcomes were measured with relative risk (...
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#1Qun Zhao (Hebei Medical University)H-Index: 13
#2Yong Li (Hebei Medical University)H-Index: 8
Last. Yuan Tian (Hebei Medical University)H-Index: 6
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AbstractObjective: To study the effects of preoperative enteral nutrition (EN) on postoperative recent nutritional status (PRNS) in patients with Siewert II and III adenocarcinomas of esophagogastric junction (AEG) after neoadjuvant chemoradiotherapy (NCRT).Methods: A total of 66 patients with resectable AEG (Siewert II and III) were randomly divided into two groups. The trial group accepted oral nutrition supplementation (ONS) for 7 days before surgery while the control not.Results: Nutrition i...
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#1Xueke Ge (Hebei Medical University)H-Index: 1
#2Qun Zhao (Hebei Medical University)H-Index: 1
Last. Xueying Qiao (Hebei Medical University)H-Index: 3
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Abstract Purpose Preoperative therapy improves overall survival (OS) after surgery in patients with adenocarcinoma of the esophagogastric junction (AEG). We aimed to retrospectively analyze whether preoperative chemoradiotherapy (CRT) could improve the prognosis of patients with locally advanced Siewert II and III AEG comparing with preoperative chemotherapy alone (CT). Patients and methods From March 2012 to December 2015, 170 patients with locally advanced (cT3-4NxM0) Siewert II and III AEG we...
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#1Xingchu Ni (Nanjing Medical University)
#2Kun (Kim) Huang (BU: Boston University)
Neoadjuvant radiation therapy or chemoradiotherapy followed by surgery has the potential to improve patient survival by reducing the risk of locoregional and distant metastasis of gastric cardiac cancer in both thoracic and abdominal organs. Because of the limited case number in prior clinical trials on the efficacy of radiation or chemoradiotherapy for gastric cardiac cancer, multicenter studies with large case numbers are urgently needed to establish an optimal therapy protocol for this cancer...
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