Locally advanced adenocarcinomas of the gastric cardia: results of pre-operative chemoradiotherapy.
Overall prognosis of adenocarcinomas of the gastro-esophageal junction remains poor as most patients present with advanced disease.


OBJECTIVE
To examine the effects of preoperative chemoradiotherapy in locally advanced adenocarcinomas of the gastro-esophageal junction.


METHODS
Forty-two consecutive patients received a course of radiotherapy (45 Gy, administred in 25 fractions) with concurrent infusion of 5-Fluorouracil and cisplatin, followed by surgery. Endoscopic ultrasonography was used to assess response to chemoradiotherapy. A transhiatal or a transthoracic approach was used for surgical resection. Tumor size, node invasion and margins of resection were analyzed.


RESULTS
Thirty-eight patients underwent subsequent surgery and complete resection (RO) was achieved in 34. Operative mortality was 13.2% (5/38). A histological complete response was observed in 6 patients. Median survival was 23 months (range: 15-31) and median disease-free survival was 19 months (range: 15-23). At one and two years, 70.7 and 45.6% of the patients were alive, respectively. The pTNM status, node involvement and tumor size were predictors of survival.


CONCLUSIONS
Pre-operative chemoradiotherapy is effective in patients with locally advanced carcinoma of the gastro-esophageal junction, resulting in high resection rates. However it seems to increase operative morbidity and mortality. Certain prognostic factors such as resection margins, need to be examined in further detail.
Balandraud
Paul
P
Service de Chirurgie Digestive, Institut Paoli-Calmette, 232 Boulevard Sainte-Marguerite, 13009 Marseille. balandraudp@yahoo.fr
Moutardier
Vincent
V
Giovannini
Marc
M
Giovannini
Marie-Hélène
MH
Lelong
Bernard
B
Guiramand
Jérôme
J
Magnin
Valérie
V
Houvenaeghel
Gilles
G
Delpero
Jean-Robert
JR
D000230:Adenocarcinoma / Q000188:drug therapy* / Q000473:pathology / Q000532:radiotherapy* / Q000601:surgery; D000328:Adult; D000368:Aged; D002299:Cardia; D003131:Combined Modality Therapy; D005240:Feasibility Studies; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D011300:Preoperative Care; D011446:Prospective Studies; D012189:Retrospective Studies; D013274:Stomach Neoplasms / Q000188:drug therapy* / Q000473:pathology / Q000532:radiotherapy* / Q000601:surgery; D015996:Survival Rate