Long-Term Efficacy of Neoadjuvant Concurrent Chemoradiotherapy for Potentially Resectable Advanced Siewert Type II and III Adenocarcinomas of the Esophagogastric Junction

Yuan Tian; Jun Wang; Xueying Qiao; Jun Zhang; Yong Li; Liqiao Fan; Zhidong Zhang; Xuefeng Zhao; Bibo Tan; Dong Wang; Peigang Yang; Qun Zhao

doi:10.3389/fonc.2021.756440

Long-Term Efficacy of Neoadjuvant Concurrent Chemoradiotherapy for Potentially Resectable Advanced Siewert Type II and III Adenocarcinomas of the Esophagogastric Junction

Front Oncol. 2021 Nov 11:11:756440. doi: 10.3389/fonc.2021.756440. eCollection 2021.

Authors

Yuan Tian¹, Jun Wang², Xueying Qiao², Jun Zhang², Yong Li¹, Liqiao Fan¹, Zhidong Zhang¹, Xuefeng Zhao¹, Bibo Tan¹, Dong Wang¹, Peigang Yang¹, Qun Zhao¹

Affiliations

¹ Third Surgery Department, The Fourth Hospital of Hebei Medical University, Shijiazhuang, China.
² Department of Radiation, The Fourth Hospital of Hebei Medical University, Shijiazhuang, China.

Abstract

Background: Reports have shown that neoadjuvant concurrent chemoradiotherapy (nCRT) increases the R0 resection rate for patients with Siewert type II or III adenocarcinoma of the gastroesophageal junction (AEG). However, the long-term efficacy of nCRT for AEG patients remains unclear. In this multicenter study, we investigated the long-term results of AEG patients treated with nCRT.

Methods: A total of 149 patients with potentially resectable advanced AEG (T3/4, Nany, M0) were randomly divided into two groups: the nCRT-treated group (treated group) (n = 76) and the surgery group (control group) (n = 73). The primary endpoint was disease-free survival (DFS), and the secondary outcome indexes included the R0 resection rate, HER-2 expression, tumor regression grade (TRG), objective response rate (ORR), disease control rate (DCR), overall survival (OS), and adverse events.

Results: In the treated group, the overall therapeutic efficacy rate was 40.8%, and the pathological complete response (pCR) rate was 16.9%. The rates of patients who underwent R0 resection in the treated and control groups were 97.0% and 87.7%, respectively (p < 0.05). The toxic effects were mainly graded 1-2 in the treated group. The median DFS times in the treated and control groups were 33 and 27 months, respectively (p = 0.08), whereas the median OS times were 39 and 30 months, respectively (p = 0.01). The median DFS times of patients with positive and negative HER-2 expression in the treated group were 13 and 43 months, respectively (p = 0.01), and the median OS times were 27 and 41 months, respectively (p = 0.01).

Conclusion: Surgery after nCRT improved the efficacy of treatment for AEG patients and thus provided a better prognosis.

Clinical trial registration: The trial is registered with ClinicalTrials.gov (number NCT01962246).

Keywords: Siewert II and III; adenocarcinoma of esophagogastric junction; advanced; neoadjuvant chemoradiotherapy; potentially resectable; treatment.

Associated data

ClinicalTrials.gov/NCT01962246