Definitive Chemoradiation for Gastroesophageal Junction (GEJ) Adenocarcinomas: A Single-Institu- tion Experience

Farshid  Farhan; Marzieh  Lashkari; Mohammad  Babaei; Shiva  Mahdavi-seriesht; Borna  Farazmand; Ebrahim  Esmati; Reza  Ghalehtaki

doi:10.18502/bccr.v15i2.18737

Farshid Farhan Department of Radiation Oncology, Cancer Institute, Imam Khomeini Hospital Complex, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
Marzieh Lashkari Department of Radiation Oncology, Cancer Institute, Imam Khomeini Hospital Complex, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
Mohammad Babaei Department of Radiation Oncology, Cancer Institute, Imam Khomeini Hospital Complex, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
Shiva Mahdavi-seriesht Department of Radiation Oncology, Cancer Institute, Imam Khomeini Hospital Complex, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
Borna Farazmand Department of Radiation Oncology, Cancer Institute, Imam Khomeini Hospital Complex, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
Ebrahim Esmati Department of Radiation Oncology, Cancer Institute, Imam Khomeini Hospital Complex, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
Reza Ghalehtaki Radiation Oncology Research Center (RORC), Cancer Research Institute, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran

DOI: https://doi.org/10.18502/bccr.v15i2.18737

Keywords: Esophagogastric Junction, Adenocarcinoma, Esophageal Neo- plasms, Chemoradiotherapy, Survival Rate, Gastric Cancer

Abstract

Background and Objectives: The non-surgical treatment outcome of gastroesoph-ageal junction (GEJ) adenocarcinoma remains to be defined. We aimed to assess theoutcomes of definitive chemoradiation (CRT) of GEJ tumors.

Methods: This retrospective cohort study was entirely carried out in the radiationoncology ward of Cancer Institute of Iran. We included patients with adenocarci-noma histology whose tumors had involved the gastro-esophageal junction and un-derwent chemoradiotherapy without surgery. In the final analysis, we evaluated 50patients with non-metastatic adenocarcinoma of GEJ (Siewert’s type I and II) from2008 to 2017. The primary outcome was overall survival; secondary outcomes wereprogression-free survival and local and distal metastasis.

Results: The reasons for not undergoing surgery in order of frequency from highestto lowest were patient refusal or medical unfitness for surgery, tumor unresectabilityor progress at the time of operation and incident metastasis in pre-op restaging, and.The 1-year, 2-year, and 3-year overall survival rates were 53%, 26%, and 12%, respec-tively. The 1-year, 2-year, and 3-year progression-free survival rates were 44%, 18%,and 10%, respectively. In the multivariate analysis, the only independent predictor ofsurvival was a distant failure (P=0.031).

Conclusion: Although the outcomes of non-surgical treatments are disappointingin GEJ adenocarcinomas, a few patients may experience long-term survival usingdefinitive CRT. This option should be discussed with all patients who are not candi-dates for surgery.