Neoadjuvant Concurrent Chemoradiation in Locally Advanced Adenocarcinoma of Gastroesophageal Junction & Proximal Stomach (A Single Arm Study): Our Experience From Single Institute From Kashmir Valley

Abstract

Introduction: The aim of this study was to investigate the efficacy and safety of using a neo-adjuvant concomitant chemoradiation therapy to treat potentially resectable adenocarcinoma of the gastroesophageal junction & proximal stomach. Methods: Thirty-nine patients having potentially resectable adenocarcinoma at the gastroesophageal junction & proximal stomach were recruited in this study to investigate the efficacy and safety of using a neoadjuvant concomitant chemoradiotherapy followed by surgery. Radiation Therapy was performed with a total of 41.4 Gy delivered in 23 sessions (05 fractions/week) along with weekly concurrent chemotherapy (Paclitaxel 50mg/m2 & Carboplatin AUC-2). Results: Of 39 patients, 38 completed the neoadjuvant concurrent chemoradiation without any severe grade 3-4 toxicities. After completion of the therapy, 89.7% had a significant endoscopic response. Thirty-five patients underwent surgery and all patients had an R0-resection. The pathological complete response rate was 14.7%. The maximum & minimum follow ups who completed the treatment protocol (neoadjuvant chemoradiation followed by surgery) reported was 16 & 02 months respectively. 02 patients recurred locally and 01 patient relapsed in bones. Overall, one year survival was 91.3%. Conclusion: The integration of neoadjuvant concurrent chemoradiation is highly effective over preoperative chemotherapy or surgery alone with acceptable toxicity rates.

Keywords

• Gastroesophageal Junction Adenocarcinoma
• Neoadjuvant Chemoradiotherapy
• Combined Modality Therapy