Retrospective Study of Neoadjuvant Treatments of Gastroesophageal Junction Cancers

Abstract

Adenocarcinoma of the gastroesophageal junction (GEJ) is a malignancy with poor prognosis. Gastric carcinoma which is increasing in incidence was reported as the second cause of cancer-related deaths worldwide. Gastric cancer has a high mortality with a current 5-year survival rate of 24%. Proximal cancers are associated with significantly worse prognosis. They usually present with a more advanced stages, more aggressive histology, and are markedly harder to resect. In preclinical models, paclitaxel with platinum compounds has synergistic effects when applied in a schedule-dependent course

Materials and Methods: Treatment plan effects on overall survival and disease-free survival were investigated statistically using Kaplan-Meier method. In order to compare treatment methods, 98 patients with gastric adenocarcinomas were selected and divided into two main groups based on the treatment and each main group has been divided into two subgroups considering their tumor grades, (T1,T2) and (T3,T4). First main group members were treated with neo-adjuvant chemoinduction (Paclitaxel 170 mg/m2 + Carboplatin Auc5-6 + FOLFOX), while second main group members were treated with chemoradiation (paclitaxel 40 mg/m2 + Carboplatin Auc2 or Cisplatin 75 mg/m2 + 5FU 750 mg/m2). Both groups received 4500-5040 cGy radiation as well. Results: The study showed chemoinduction treatment has significant effect on disease free survival of patients in both subgroups (p-value <0.05). However, there is no noteworthy relation between this treatment and overall survival of patients.