title: Effect of preoperative chemoradiotherapy on outcome of patients with locally advanced esophagogastric junction adenocarcinoma-a pilot study.
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, thereby 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-fluorouracil-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% confidence 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 adenocarcinoma, but shows mild efficacy, as suggested by the low rate of pathologic complete response.
authors.affiliation: Division of Medical Oncology, Department of Clinical and Experimental Medicine and Surgery, Second University of Naples School of Medicine, Naples, Italy.
authors.forename: M
authors.initials: M
authors.lastname: Orditura
authors.affiliation: Divisions of Surgical Oncology, Department of Anesthesiologic, Surgical, and Emergency Sciences, Second University of Naples School of Medicine, Naples, Italy.
authors.forename: G
authors.initials: G
authors.lastname: Galizia
authors.affiliation: Divisions of Surgical Oncology, Department of Anesthesiologic, Surgical, and Emergency Sciences, Second University of Naples School of Medicine, Naples, Italy.
authors.forename: N
authors.initials: N
authors.lastname: Di Martino
authors.affiliation: Division of General Surgery 1, University of Padua, School of Medicine, Padua, Italy.
authors.forename: E
authors.initials: E
authors.lastname: Ancona
authors.affiliation: Division of General Surgery 1, University of Padua, School of Medicine, Padua, Italy.
authors.forename: C
authors.initials: C
authors.lastname: Castoro
authors.affiliation: Division of Radiotherapy, Federico ii University of Naples School of Medicine, Naples, Italy.
authors.forename: R
authors.initials: R
authors.lastname: Pacelli
authors.affiliation: Division of Medical Oncology, Department of Clinical and Experimental Medicine and Surgery, Second University of Naples School of Medicine, Naples, Italy.
authors.forename: F
authors.initials: F
authors.lastname: Morgillo
authors.affiliation: Division of Medical Oncology, Department of Clinical and Experimental Medicine and Surgery, Second University of Naples School of Medicine, Naples, Italy.
authors.forename: S
authors.initials: S
authors.lastname: Rossetti
authors.affiliation: Division of Medical Oncology, Department of Clinical and Experimental Medicine and Surgery, Second University of Naples School of Medicine, Naples, Italy.
authors.forename: V
authors.initials: V
authors.lastname: Gambardella
authors.affiliation: Division of Radiotherapy, Federico ii University of Naples School of Medicine, Naples, Italy.
authors.forename: A
authors.initials: A
authors.lastname: Farella
authors.affiliation: Division of Medical Oncology, Department of Clinical and Experimental Medicine and Surgery, Second University of Naples School of Medicine, Naples, Italy.
authors.forename: M M
authors.initials: MM
authors.lastname: Laterza
authors.affiliation: Division of General Surgery 1, University of Padua, School of Medicine, Padua, Italy.
authors.forename: A
authors.initials: A
authors.lastname: Ruol
authors.affiliation: Division of Medical Oncology, Department of Clinical and Experimental Medicine and Surgery, Second University of Naples School of Medicine, Naples, Italy.
authors.forename: A
authors.initials: A
authors.lastname: Fabozzi
authors.affiliation: Divisions of Surgical Oncology, Department of Anesthesiologic, Surgical, and Emergency Sciences, Second University of Naples School of Medicine, Naples, Italy.
authors.forename: V
authors.initials: V
authors.lastname: Napolitano
authors.affiliation: Divisions of Surgical Oncology, Department of Anesthesiologic, Surgical, and Emergency Sciences, Second University of Naples School of Medicine, Naples, Italy.
authors.forename: F
authors.initials: F
authors.lastname: Iovino
authors.affiliation: Divisions of Surgical Oncology, Department of Anesthesiologic, Surgical, and Emergency Sciences, Second University of Naples School of Medicine, Naples, Italy.
authors.forename: E
authors.initials: E
authors.lastname: Lieto
authors.affiliation: Divisions of Surgical Oncology, Department of Anesthesiologic, Surgical, and Emergency Sciences, Second University of Naples School of Medicine, Naples, Italy.
authors.forename: L
authors.initials: L
authors.lastname: Fei
authors.affiliation: Divisions of Surgical Oncology, Department of Anesthesiologic, Surgical, and Emergency Sciences, Second University of Naples School of Medicine, Naples, Italy.
authors.forename: G
authors.initials: G
authors.lastname: Conzo
authors.affiliation: Division of Medical Oncology, Department of Clinical and Experimental Medicine and Surgery, Second University of Naples School of Medicine, Naples, Italy.
authors.forename: F
authors.initials: F
authors.lastname: Ciardiello
authors.affiliation: Division of Medical Oncology, Department of Clinical and Experimental Medicine and Surgery, Second University of Naples School of Medicine, Naples, Italy.
authors.forename: F
authors.initials: F
authors.lastname: De Vita
keywords: Preoperative chemoradiotherapy; folfox4; gastroesophageal junction cancer