Efficacy And Safety Analysis Of Preoperative Concurrent Chemoradiotherapy For Patients With Locally Advanced Adenocarcinoma Of Esophagogastric Junction In Siewert's Type ? And ?

Objective: To analyze the efficacy and safety of concurrent preoperative chemoradiotherapy for patients with locally advanced adenocarcinoma of esophagogastric junction(AEG) in Siewert's type II and III.Methods: A total of 75 cases were involved into the study. Patients received two cycles of chemotherapy with XELOX and concurrent radiotherapy(a total of 45 Gy in 25 fractions, 1.8Gy per day for five weeks). They underwent operation 6 to 8 weeks later when neoadjuvant chemoradiotherapy had finished. After the surgery, patients received 6 cycles of adjuvant chemotherapy. The efficacy and survival of preoperative concurrent chemoradiotherapy were analyzed, and toxicity was evaluated.Results: All of 75 patients had completed irradiation. Sixty-four patients finished 2 cycles of concurrent chemotherapy, and eleven patients finished 1 cycle of concurrent chemotherapy. Short-term efficacy analysis could be available from 72 cases, the overall response rate(ORR) was 68.1%(49/72), and fives cases experienced disease progression. Forty-five patients received surgery, and the R0 resection rate was 93.3%(42/45). The rate of pathological complete response(pCR) was 22.2%(10/45). The patients assessed with tumor regression grade 0 to grade 3 were 10(22.2%), 17(37.8%), 15(33.3%), 3(6.7%), respectively. After neoadjuvant chemoradiotherapy, 24 cases with T down-staging and 26 cases with N down-staging were observed. The 1-, 2-year of PFS rate of patients who received surgery and who did not receive surgery were 82.3%, 68.3% and 60.1%, 28.0%, respectively(?2=15.551, P=0.000). The 1-, 2-year OS rate of patients who had surgery after concurrent chemoradiotherapy and those who didn't receive the operation were 94.4 %, 79.4% and 69.0%, 40.6%, respectively(?2=11.230, P=0.001). Multivariate analysis showed that surgery, concurrent chemotherapy cycles, distant metastases, were independent factors for PFS(P=0.001, P=0.012, P=0.000),and surgery, distant metastases were independent factors for OS(P=0.046, P=0.000). The most common non-hematologic toxicity was gastrointestinal reactions, the incidence of nausea, vomiting and anorexia were 66.7%(50/75), 29.3%(22/75) and 76.0%(57/75), respectively. The incidence of leukocytopenia, thrombocytopenia and neutropenia were 56.0%(42/75), 45.3%(34/75) and 41.3%(31/75), respectively. None of the grade 4-5 non-hematological and hematological toxicities were observed. One case died of pulmonary infection after chemoradiotherapy, and another died of severe ARDS after surgery.Conclusions:Concurrent chemoradiotherapy before surgery for locally advanced AEG with Siewert's type II and III could achieve the down-staging disease, get higher R0 resection rate and pCR rate. Concurrent neoadjuvant chemoradiotherapy is well tolerated and could be performed for locally advanced AEG patients with Siewert's type II and III. Surgery, distant metastases are independent prognostic factors for OS and surgery, distant metastases, concurrent chemotherapy cycles are independent prognostic factors for PFS.