Effect of preoperative chemoradiotherapy on outcome of patients with locally advanced esophagogastric junction adenocarcinoma-a pilot study

M. Orditura, G. Galizia, N. Di Martino, E. Ancona, C. Castoro, R. Pacelli, F. Morgillo, S. Rossetti, V. Gambardella, A. Farella, M. M. Laterza, A. Ruol, A. Fabozzi, V. Napolitano, F. Iovino, E. Lietoa, L. Fei, G. Conzo, F. Ciardiello, F. De Vita

Research output: Contribution to journalArticle

12 Citations (Scopus)

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, there by 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-fuorouracil-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% confdence 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 ad-enocarcinoma, but shows mild efficacy, as suggested by the low rate of pathologic complete response.

Original languageEnglish
Pages (from-to)125-133
Number of pages9
JournalCurrent Oncology
Volume21
Issue number3
DOIs
Publication statusPublished - 2014

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Esophagogastric Junction
Chemoradiotherapy
Adenocarcinoma
oxaliplatin
Conformal Radiotherapy
Neoplasms
Surgical Pathology
Leucovorin
Neoplasm Staging
Esophageal Neoplasms
Stomach Neoplasms
Disease Progression
Therapeutics
Multivariate Analysis
Survival Rate
Tomography
Safety
Drug Therapy
Survival

Keywords

  • FOLFOX4
  • Gastroesophageal junction cancer
  • Preoperative chemoradiotherapy

ASJC Scopus subject areas

  • Oncology

Cite this

Effect of preoperative chemoradiotherapy on outcome of patients with locally advanced esophagogastric junction adenocarcinoma-a pilot study. / Orditura, M.; Galizia, G.; Di Martino, N.; Ancona, E.; Castoro, C.; Pacelli, R.; Morgillo, F.; Rossetti, S.; Gambardella, V.; Farella, A.; Laterza, M. M.; Ruol, A.; Fabozzi, A.; Napolitano, V.; Iovino, F.; Lietoa, E.; Fei, L.; Conzo, G.; Ciardiello, F.; De Vita, F.

In: Current Oncology, Vol. 21, No. 3, 2014, p. 125-133.

Research output: Contribution to journalArticle

Orditura, M, Galizia, G, Di Martino, N, Ancona, E, Castoro, C, Pacelli, R, Morgillo, F, Rossetti, S, Gambardella, V, Farella, A, Laterza, MM, Ruol, A, Fabozzi, A, Napolitano, V, Iovino, F, Lietoa, E, Fei, L, Conzo, G, Ciardiello, F & De Vita, F 2014, 'Effect of preoperative chemoradiotherapy on outcome of patients with locally advanced esophagogastric junction adenocarcinoma-a pilot study', Current Oncology, vol. 21, no. 3, pp. 125-133. https://doi.org/10.3747/co.21.1570
Orditura, M. ; Galizia, G. ; Di Martino, N. ; Ancona, E. ; Castoro, C. ; Pacelli, R. ; Morgillo, F. ; Rossetti, S. ; Gambardella, V. ; Farella, A. ; Laterza, M. M. ; Ruol, A. ; Fabozzi, A. ; Napolitano, V. ; Iovino, F. ; Lietoa, E. ; Fei, L. ; Conzo, G. ; Ciardiello, F. ; De Vita, F. / Effect of preoperative chemoradiotherapy on outcome of patients with locally advanced esophagogastric junction adenocarcinoma-a pilot study. In: Current Oncology. 2014 ; Vol. 21, No. 3. pp. 125-133.
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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, there by 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-fuorouracil-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{\%} confdence 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 ad-enocarcinoma, but shows mild efficacy, as suggested by the low rate of pathologic complete response.",
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T1 - Effect of preoperative chemoradiotherapy on outcome of patients with locally advanced esophagogastric junction adenocarcinoma-a pilot study

AU - Orditura, M.

AU - Galizia, G.

AU - Di Martino, N.

AU - Ancona, E.

AU - Castoro, C.

AU - Pacelli, R.

AU - Morgillo, F.

AU - Rossetti, S.

AU - Gambardella, V.

AU - Farella, A.

AU - Laterza, M. M.

AU - Ruol, A.

AU - Fabozzi, A.

AU - Napolitano, V.

AU - Iovino, F.

AU - Lietoa, E.

AU - Fei, L.

AU - Conzo, G.

AU - Ciardiello, F.

AU - De Vita, F.

PY - 2014

Y1 - 2014

N2 - 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, there by 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-fuorouracil-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% confdence 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 ad-enocarcinoma, but shows mild efficacy, as suggested by the low rate of pathologic complete response.

AB - 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, there by 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-fuorouracil-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% confdence 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 ad-enocarcinoma, but shows mild efficacy, as suggested by the low rate of pathologic complete response.

KW - FOLFOX4

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