Neoadjuvant chemoradiotherapy improves survival in locally advanced adenocarcinoma of esophagogastric junction compared with neoadjuvant chemotherapy: a propensity score matching analysis.

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. METHODS: 170 Patients with locally advanced (cT3-4NxM0) Siewert II and III adenocarcinoma of the esophagogastric junction (AEG) were treated with neoadjuvant chemotherapy consisting of capecitabine plus oxaliplatin with or without concurrent radiotherapy in the Fourth Hospital of Hebei Medical University. Intensity-modulated radiation therapy (IMRT) was used and delivered in 5 daily fractions of 1.8 Gy per week for 5 weeks (total dose of PTV: 45 Gy). 120 Patients were included in the propensity score matching (PSM) analysis to compare the effects of nCRT with nCT on survival. RESULTS: With a median follow-up of 41.2 months for patients alive after propensity score matching analysis, the 1- and 3-year OS were 84.8%, 55.0% in nCRT group and 78.3%, 38.3% in nCT group (P = 0.040; HR = 1.65, 95% CI 1.02-2.69). The 1- and 3-year PFS were 84.9%, 49.2% in nCRT group and 68.3%, 29.0% in nCT group (P = 0.010; HR = 1.80, 95% CI 1.14-2.85). The pathological complete response (pCR) was 17.0% in nCRT group and 1.9% in nCT group (P = 0.030). No significant difference was observed in postoperative complications between the two groups. CONCLUSION: The nCRT confers a better survival with improved R0 resection rate and pCR rate compared with nCT for the patients with locally advanced AEG.

Comparison of preoperative concurrent chemoradiotherapy with chemotherapy alone in patients with locally advanced siewert II and III adenocarcinoma of the esophagogastric junction.

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 were treated with preoperative CRT or CT in Hebei Medical University Fourth Hospital, and 123 patients were included in this study to compare the effects of preoperative CRT with CT. RESULTS: R0 resection rate was 96.7% in CRT group and 82.5% in CT group (P = .016). The pathological complete response was 16.7% after CRT group and 3.2% after CT (P = .015). The median follow-up time was 20 months. The 1- and 3-year OS were 89.4%, 79.2% in CRT group and 88.2%, 58.0% in CT group (P = .016; HR = 0.40, 95% confidence interval 0.21-0.76). The 1- and 3-year PFS were 87.3%, 73.5% in CRT group and 72.8%, 42.8% in CT group (P = .014; HR = 0.46, 95% confidence interval 0.24-0.86). Multivariate analysis showed that clinical T stage, adjuvant chemotherapy cycles and histologic differentiation were shown to be the independent prognostic factors for OS, and postoperative pathologic N stage was shown to be the independent prognostic factor for PFS. CONCLUSION: For the patients with locally advanced AEG, the addition of radiotherapy to preoperative chemotherapy can improve survival with safety, but is not an independent prognostic factor for OS and PFS.