[Preliminary results of neoadjuvant treatment of adenocarcinoma of the gastro-esophageal junction].
The prognosis of adenocarcinoma of the gastro-oesophageal junction is poor and only surgery yields long-term survival in no more than 30% of patients. We tested a new neoadjuvant chemo-radiotherapy regimen based on the administration of weekly docetaxel and cisplatin and continuous infusion of 5-FU with concurrent radiotherapy in order to evaluate its feasibility and efficacy. Thirty-three patients enrolled in a dose-finding study and observed at the 1st Division of General Surgery of the University of Verona between January 2000 and October 2003 underwent neoadjuvant chemo-radiotherapy for gastro-oesophageal junction adenocarcinoma (Siewert type I and II). The induction treatment was completed in 97.0% of cases with no treatment-related mortality. After completion of chemo-radiation 30 patients underwent surgery (90.9%) while three patients did not (progression in 2 cases and chemotherapy toxicity in one). Two operated patients did not undergo resection because of liver metastasis at laparotomy (respectability: 84.8%) and 3 more cases had incomplete tumour resection (R0-resectability: 75.8%). No postoperative in-hospital mortality was observed. A complete response (pT0N0) was achieved in 7 cases (23.3%) while minimal residual disease without evidence of lymph node involvement was found in a further 5 cases (16.7%). Worthy of note is the high rate of positive histopathological responses in the later period (6 out of 8) with 4 cases presenting complete responses. This protocol regimen proved to be feasible and well tolerated. Surgery-related deaths and morbidity were not increased. A high rate of positive pathological responses was obtained particularly in the later period of the study with the increased dosage of the protocol regimen.
Pedrazzani
Corrado
C
Prima Divisione Clinicizzata di Chirurgia Generale, Università di Verona.
Pasini
Felice
F
Giacopuzzi
Simone
S
Bernini
Marco
M
Gabbani
Milena
M
Grandinetti
Antonio
A
Tomezzoli
Anna
A
Ruzzenente
Andrea
A
Guglielmi
Alfredo
A
de Manzoni
Giovanni
G
D000230:Adenocarcinoma / Q000188:drug therapy* / Q000473:pathology / Q000601:surgery; D000328:Adult; D000368:Aged; D000972:Antineoplastic Agents, Phytogenic / Q000008:administration & dosage; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D002945:Cisplatin / Q000008:administration & dosage; D000077143:Docetaxel; D004938:Esophageal Neoplasms / Q000188:drug therapy* / Q000473:pathology / Q000601:surgery; D004943:Esophagogastric Junction / Q000473:pathology / Q000601:surgery; D005260:Female; D005472:Fluorouracil / Q000008:administration & dosage; D006801:Humans; D008297:Male; D008875:Middle Aged; D020360:Neoadjuvant Therapy / Q000379:methods*; D009367:Neoplasm Staging; D012189:Retrospective Studies; D013274:Stomach Neoplasms / Q000188:drug therapy* / Q000473:pathology / Q000601:surgery; D016019:Survival Analysis; D043823:Taxoids / Q000008:administration & dosage; D016896:Treatment Outcome
D000972:Antineoplastic Agents, Phytogenic; D043823:Taxoids; D000077143:Docetaxel; D002945:Cisplatin; D005472:Fluorouracil