title: Survival after adjuvant chemoradiotherapy or surgery alone in resectable adenocarcinoma at the gastro-esophageal junction.
abstract: OBJECTIVE
  Longterm survival after curative resection for adenocarcinoma at the gastro-esophageal junction (GEJ) range between 18% and 50%. In the pivotal Intergroup-0116 Phase III trial by Macdonald et all, adjuvant chemoradiotherapy improved both disease-free and overall survival in curatively resected patients with mainly gastric adenocarcinoma. We compared survival data for curatively resected patients with adeno-carcinoma solely at the gastro-esophageal junction (GEJ), treated with surgery alone or surgery and adjuvant chemoradio-therapy.
  
  
  METHODS
  From 2003 to 2009, 211 patients underwent curative resection. Surgery alone was performed in 95 pa-tients and 116 patients received adjuvant therapy after resection. All patients underwent Lewis-Tanner operation with D1 node resection including coliac nodes (D1+). Informations about recurrence and death were collected from the Danish Cancer Register and the Central Death Register. Patients who died after experiencing severe complications after surgery were excluded from the survival analysis. Patients with T0N0 or T1N0 were also excluded because patients of this category were not given adjuvant therapy according to the Macdonald protocol.
  
  
  RESULTS
  Patients with positive node status in the resected specimen, the 3-year disease-free survival after adjuvant chemoradiotherapy (n = 91) or surgery alone (n = 43) was 24% and 37%, respectively. Median time of survival was prolonged by 10 month in favour of those who received chemoradiotherapy. However, after controlling for the confounding effect of age and node status, only positive node status in the resected specimen had significant partial effect on survival.
  
  
  CONCLUSIONS
  Chemoradiotherapy according to the Intergroup-0116 protocol might still be a reasonable option after curative resection in patients with GEJ adenocarcinomas and positive lymph node status, who did not receive neoadjuvant chemotherapy.
authors.affiliation: Department of Surgical Gastroenterology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark. steenkofoed@hotmail.com
authors.forename: S C
authors.initials: SC
authors.lastname: Kofoed
authors.forename: A
authors.initials: A
authors.lastname: Muhic
authors.forename: L
authors.initials: L
authors.lastname: Baeksgaard
authors.forename: M
authors.initials: M
authors.lastname: Jendresen
authors.forename: J
authors.initials: J
authors.lastname: Gustafsen
authors.forename: J
authors.initials: J
authors.lastname: Holm
authors.forename: L
authors.initials: L
authors.lastname: Bardram
authors.forename: B
authors.initials: B
authors.lastname: Brandt
authors.forename: J
authors.initials: J
authors.lastname: Brenø
authors.forename: L B
authors.initials: LB
authors.lastname: Svendsen
mesh_terms: D000230:Adenocarcinoma / Q000401:mortality* / Q000601:surgery / Q000628:therapy*; D000368:Aged; D059186:Chemoradiotherapy, Adjuvant; D018572:Disease-Free Survival; D004943:Esophagogastric Junction; D005260:Female; D006801:Humans; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D011879:Radiotherapy Dosage; D013274:Stomach Neoplasms / Q000401:mortality* / Q000628:therapy*