| Adenocarcinoma of the esophagogastric junction,a special type of gastric cancer,has more abominable biological behavior.The main treatment for stage Ⅲ adenocarcinoma of the esophagogastric junction is surgical resection combined with systemic chemotherapy.The most critical factor determining prognosis is whether R0 can be resected.How to improve the rate of R0 resection is a hot and focal point in the clinical study of the adenocarcinoma of the esophagogastric junction in stage Ⅲ.One of the main objectives of the neoadjuvant therapy is to increase the rate of R0 resection.In the field of neoadjuvant therapy for adenocarcinoma of the esophagogastric junction,the most widely used chemotherapy is platinum and 5-FU based chemotherapy.Its efficacy and safety are not satisfactory.In clinical practice,it is found that paclitaxel plus carboplatin(TP)chemotherapy has excellent effect on adenocarcinoma of the esophagogastric junction,and has the advantages of little toxicity and tolerance.The anatomical location of the adenocarcinoma of the esophagogastric junction is relatively fixed,and it is easy to locate the radiotherapy.Paclitaxel-carboplatin single-week regimen based chemotherapy combined with concurrent radiotherapy is used in the neoadjuvant treatment of the adenocarcinoma of the stage Ⅲ of the esophagogastric junction.Is it a better and safer treatment.Methods: The clinical diagnosis of stage Ⅲ esophagogastric junction adenocarcinoma in First Affiliated Hospital of Hebei North University from December 2014 to November 2017 was collected and randomly divided into the experimental group(preoperative concurrent chemoradiotherapy group)and the control group(direct operation group).All the patients had underwent gastroscopy,ultrasound gastroscopy,pathological examination,chest and abdominal spiral CT,cranial magnetic resonance imaging,abdominal ultrasonography,blood routine,biochemical items,tumor markers and other related examinations,and signed informed consent.The 19 patients in the experimental group were given paclitaxel 80mg/m2 combined with carboplatin AUC=1.5 on the first day.One week after the interval,the vein was repeated for 9 weeks(9 times for intravenous administration).Radiation therapy(40Gy/20F/4W)was added to the Second week of chemotherapy.After 6-8 weeks of rest in chemotherapy end,D2 was given to the patients.20 patients in the control group were treated with D2 radical operation.Both the experimental group and the control group were given adjuvant chemotherapy.Evaluate the efficacy of neoadjuvant chemoradiation :First,the rate of R0 resection and the positive rate of postoperative lymph nodes were compared between the two groups.Second,to compare the clinical staging before and after neoadjuvant chemoradiation,to compare the postoperative pathological staging between the two groups and to calculate the efficiency of the neoadjuvant chemoradiation.Third,observe the changes of dietary status during the course of neoadjuvant chemoradiation.Fourth,Gastroscopy and imaging of primary tumor before and after neoadjuvant chemoradiation were compared.Fifth,the pathological changes of pathology and the change of Ki-67 after neoadjuvant chemoradiation were compared.It was evaluated the side effects,surgical mortality and postoperative complications of neoadjuvant chemoradiation.Results:(1)The resection rate of R0(94.7%)in the experimental group was significantly higher than that of the control group(50.0%),which was statistically significant(P < 0.05).The number of lymph node metastases in the experimental group was 4.89±3.59 after operation,and the number of lymph node metastases in the control group was 8.78±2.76 after operation.The difference of lymph node metastasis between the two groups was statistically significant(P < 0.05).(2)The changes of clinical staging before and after neoadjuvant chemoradiation as follows: phase Ⅲ is dropped to I in 5 cases(26.3%);Ⅲ phase dropped to II in 12 cases(63.1%);Ⅲ phase unchanged in 2 cases(10.4%);Ⅲ phase dropped to 0 cases(0%)in IV phase.The curative effect of neoadjuvant The changes of clinical staging before and after neoadjuvant chemoradiation were as follows:CR 4 cases(21%),PR(68.4%)13 cases,SD 2 cases(10.4%),0 cases of PD(0%).The pathological stage of the neoadjuvant chemotherapy group were as follows:I stage: 3 cases,14 cases in II stage,2 cases in Ⅲ phase compared with the direct operation group Ⅲ stage: 18 cases.The changes in dietary status during neoadjuvant chemoradiation were as follows: 16 patients on liquid diet difficulties,3 patients only liquid diet;after 3 weeks of treatment,9 cases of patients with liquid diet difficulties,8 patients into the liquid diet,2 patients in the semi liquid diet;after 6 weeks of treatment in 2 patients into the liquid diet,13 patients into the semi liquid diet,4 patients with normal diet;after 9 weeks of treatment,4 patients with semi liquid diet,15 patients normal diet;after 12 weeks of treatment,all 19 patients eating normally.Comparison of imaging and gastroscopy data before and after neoadjuvant chemoradiation were as follows::The result of spiral CT,the range of gastric wall thinning at the primary focus and the range of enhanced signal depth was decreased,reduced the lymph nodes in the gastric peri.The results of gastroscopy were smaller than those before treatment and lesions tended to be healed.The results of ultrasonic gastroscopy were smaller than those before the treatment and the structure of each layer could be divided into different layers,the surrounding lymph nodes reduced.Pathological results: the invasion of cancer cells was reduced or the number of cells less,compared with preoperative pathology.There were lymphocytic and plasma infiltration and fibrosis in different levels of the gastric wall.In the experimental group,the positive rate of Ki-67 was 63.1% before neoadjuvant therapy and the positive rate of Ki-67 expression was 47.4% after operation,which was lower than that before neoadjuvant chemoradiation.But the Ki-67 expression difference was not statistically significant(P>0.05).Safety evaluation of neoadjuvant chemoradiation:the reactions of neoadjuvant chemoradiation were mainly the 3-4 side adverse alopecia(42.1%)and leukocyte reduction(15.7%).All the adverse reactions were properly treated and the symptoms were relieved or disappeared.The mortality of patients of chemotherapy,radiotherapy and operation was 0%.There were no operative complications in the experimental group.In the control group,there were 1 cases of intestinal obstruction(functional,discharged after conservative treatment),no postoperative complications such as postoperative bleeding,anastomotic leakage,anastomotic stenosis and other related complications.Conclusion:(1)The clinical staging of the adenocarcinoma of the esophagogastric junction at stage Ⅲ could be reduced by the new adjuvant chemotherapy radiotherapy single week(TP).(2)Compared with the control group,the neoadjuvant chemoradiation one week(TP)program can significantly improve the R0 resection rate and reduce lymph node metastasis rate in patients with stage Ⅲ esophagogastric junction adenocarcinoma.(3)The clinical symptoms of feeding obstruction of adenocarcinoma of the stage Ⅲ of esophagogastric junction can be obviously improved by the new assisted synchronous chemoradiation single week(TP).(4)The new adjuvant synchronous chemoradiation single week(TP)scheme does not increase the mortality and postoperative complications,the side effects of chemoradiation are small,which can be controlled clinically.(5)The new adjuvant synchronous chemoradiation single week(TP)regimen is very effective for neoadjuvant treatment of stage Ⅲ esophagogastric junction adenocarcinoma.It can be used as the preferred scheme for neoadjuvant treatment of adenocarcinoma of the esophagogastric junction in stage Ⅲ. |
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