Adjuvant Chemoradiotherapy Vs Neoadjuvant/Perioperative Chemotherapy in Resectable Gastro-esophageal Junction Adenocarcinomas- a Retrospective Analysis

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dc.contributor.authorSharma, Rahulen_US
dc.date.accessioned2020-10-16T09:00:38Z
dc.date.available2020-10-16T09:00:38Z
dc.date.issued2019-04
dc.description.abstractWe aimed to conduct the retrospective analysis of resectable Gastro-esophageal junctionadenocarcinomas treated at our facility with either adjuvant chemoradiotherapy (ACT) or neoadjuvant/perioperative chemotherapy (NACT) and investigate their impact on the clinical outcome.A total of79 patients of Gastro -esophageal junction adenocarcinomas completed treatment with curative intentbetween January, 2010 and December 2016 and were included in the analysis. 33 patients receivedadjuvant chemoradiotherapy after curative surgery as per Intergroup 0116 protocol. 46 patientsunderwent curative surgery after 3 cycles of neoadjuvant /perioperative chemotherapy as per UKMAGIC trial regimen. Statistical analysis was done with SPSS version 16 software.The patientsincluded 68 males and 11 females with age ranging from 22-81 years (median 60 years). The followup ranged from 6-71 months (median 14 months). The number of lymph nodes removed at surgerywas 5-25 (median 12). Only 6 patients were node negative in the whole cohort. The number ofpositive lymph nodes ranged from 1-9 in rest of the 73 patients. 12.65% (n=10) patients were diagnosedwith stage IIB, 44.3% (n=35) patients had stage IIIA, 29.1 %( n= 23) patients had stage IIIB and13.9% (n=11) patients had stage IIIC disease. In the adjuvant chemoradiotherapy group, out of 33patients, 7 were dead of disease and 12 were alive with disease at last follow up. In the neoadjuvant/perioperative cohort, out of 46 patients, 13 were dead and 16 were alive with disease. Mediandisease free survival in the adjuvant chemoradiotherapy group was 22 months versus 14 months inthe neoadjuvant/perioperative cohort. The difference was significant on Breslow analysis (GeneralizedWilcoxon, p=.014) and on Tarone Ware (p=.037) but not on Log rank (Mantel-Cox, p=.190) implyingmore of the early events in the NACT group. Hazards ratio for ACT vs. NACT was 0 .703(95% CI0.376-1.317, p=0.272). Hazard ratio for positive nodes was 1.125 ( 95% CI 0.96-1.318,p=0.145).Median DFS for the whole group was18 months(SE 2.912,CI 12.292-23.708) and meanDFS was 23.725 months (SE 2.452, CI 18.919-28.532). Patients receiving adjuvant chemotherapyafter surgery had median overall survival of 39 months versus 26 months in the neoadjuvant arm{p=.039, Wilcoxon Gehan statistic}.In our clinical set-up, adjuvant chemoradiotherapy seems to resultin better overall survival and disease free survival in resectable gastro-esophageal junctionadenocarcinoma though we should be cautious in interpreting retrospective and non-randomizeddata.en_US
dc.identifier.affiliationsDepartment of Radiotherapyen_US
dc.identifier.affiliationsGovt Medical College Jammuen_US
dc.identifier.affiliationsJ&K Indiaen_US
dc.identifier.citationSharma Rahul. Adjuvant Chemoradiotherapy Vs Neoadjuvant/Perioperative Chemotherapy in Resectable Gastro-esophageal Junction Adenocarcinomas- a Retrospective Analysis. JK Science Journal of Medical Education and Research. 2019 Apr; 2019 Apr: 81-87en_US
dc.identifier.issn0972-1177
dc.identifier.placeIndiaen_US
dc.identifier.urihttps://imsear.searo.who.int/handle/123456789/210968
dc.languageenen_US
dc.publisherJK Scienceen_US
dc.relation.issuenumber2en_US
dc.relation.volume21en_US
dc.source.urihttps://www.jkscience.org/archives/volume212/8-Original%20Article.pdfen_US
dc.subjectGastroesophageal Junctionen_US
dc.subjectAdenocarcinomaen_US
dc.subjectPerioperative Chemotherapyen_US
dc.subjectAdjuvant Chemoraditherapyen_US
dc.titleAdjuvant Chemoradiotherapy Vs Neoadjuvant/Perioperative Chemotherapy in Resectable Gastro-esophageal Junction Adenocarcinomas- a Retrospective Analysisen_US
dc.typeJournal Articleen_US
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