Adenocarcinoma of the esophagogastric junction: neoadjuvant radiochemotherapy and radical surgery : early results and toxicity.

作者: Bernhard J. Leibl , Stephanie Vitz , Wolfgang Schäfer , Martin Alfrink , Andreas Gschwendtner

DOI: 10.1007/S00066-011-2171-4

关键词:

摘要: To retrospectively evaluate treatment results and toxicity following a combined approach consisting of neoadjuvant radiochemotherapy radical surgery in advanced adenocarcinoma the esophagus gastroesophageal junction. Between 2005 2009, total 41 consecutive patients with newly diagnosed nonmetastatic adeno-carcinoma esophagogastric junction were evaluated, whom 23 received radiochemo-therapy (RCT). A dose 50.4 Gy 2 cycles simultaneous cisplatin/5-fluorouracil (FU) or Taxol/FU–chemotherapy applied. transthoracic subtotal esophageal proximal gastric resection through right thoracoabdominal laparotomy intrathoracic anastomosis was performed 6–8 weeks RCT. This two-field lymphadenectomy mediastinal abdominal lymph nodes. Standard histopathological evaluation included application regression grading according to Werner Hofler. Toxicity recorded on basis CTC criteria; survival curves calculated Kaplan–Meier. V10, V15, V20 data correlated pulmonary toxicity. Overall for all 61% at 3 years. Of original patients, 18 (78%) proceeded surgery. Reasons no age 79, 82, 86 years (n = 3), severe comorbidity 1), progression during 1). Surgical morbidity (grade 3–4) mortality rates 35% 6%, respectively. Resurgery necessary cases (18%). Clear margins achieved 17 (94%). Twelve (67%) initially T3 tumors T4 experienced downstaging. The ypN0 rate 12 (67%). Out revealed 50% viable cells 1 patient. During postoperative course thereafter, 8 (35%) complications including pneumonia and/or pneumonitis. V10 > 20% (p 0.019), V15 13% 0.008), 10% 0.008) associated significant increase toxic effects. Neoadjuvant followed by is feasible concept. Significant tumor 44% an 67% may favor this due its high efficacy. However, avoid effects constraints low-dose radiation volume parameters need specific attention.

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