Peri-operative Chemotherapy in Patients with Oesophageal and Gastro-oesophageal Junction Cancer – Three Years of Experience

Abstract

R e c e i ve d N ove m b e r 6 , 2 0 1 2 ; A c c e p t e d A p r i l 8 , 2 0 1 3 . Key words: Oesophageal and gastro-oesophageal junction adenocarcinomaPeri-operative chemotherapyAbstract: Peri-operative chemotherapy has been found to benefit patients with oesophageal and gastro-oesophageal junction adenocarcinoma. This study's aim was to evaluate the efficacy and tolerance of this treatment. The study included patients with carcinoma of the lower oesophagus and gastro-oesophageal junction in whom the disease was evaluated as potentially operable. Chemotherapy (CHT) consisted of three preoperative and three postoperative cycles of intravenous epirubicin and cisplatin on day 1 plus a continuous infusion of fluorouracil for 21 days (ECF) or oral capecitabine for 14 days (ECCap). Postoperative radio-chemotherapy (CRT) with fluorouracil or capecitabine after CHT was indicated in patients with two and more positive lymph nodes. Sixty-three patients started the treatment. Median follow-up was 32 months. Preoperative CHT was completed by 62 patients, 52 had surgery, 46 had radical resection, 25 patients had pN0 and 21 patient pN plus findings. Postoperative CHT was started in 39 (62%) patients and completed in 32 (51%). Ten (16%) patients had postoperative CRT. Adverse events of grade 3 and 4 were: neutropenia 17%, vomiting 8%, fatigue 5%, diarrhoea 3%. Reasons for omitting surgery in 11 (17%) patients were: progression in 7 patients, medically unfit in 3 patients, other in 1 patient. In the reporting period there were recurrences in 39 of all patients, in 7 locoregional only, in 10 distant plus locoregional, and in 19 distant metastases. Median survival was 24.1 months and 3-year survival rate was 42%. Peri-operative chemotherapy ECF/ECCap was feasible and well tolerated. Radical resection was performed in most patients.

[18F]Fluorodeoxyglucose PET/CT and prediction of histopathological response to neoadjuvant chemotherapy for adenocarcinoma of the oesophagus and oesophagogastric junction

“…Chemotherapy included three preoperative and three postoperative cycles of epirubicin (50 mg/m 2 ) and cisplatin (60 mg/m 2 ) intravenously on day 1, plus a continuous infusion of fluorouracil (200 mg/m 2 per day) with a portable infusion pump for 21 days or oral capecitabine (1000 mg/m 2 twice a day) for 14 days in a 21‐day cycle. Details of the chemotherapy regimen and its modifications in the present cohort have been described previously.…”

“…Details of the chemotherapy regimen and its modifications in the present cohort have been described previously 20 .…”

“…Forty-seven patients underwent PET2 on day 12-16 (median 14 (i.q.r. 14-15) days) after the start of chemotherapy (group A), and the remaining 43 had PET2 later (median 20 (18)(19)(20) days) (group B). The two groups did not differ in baseline metabolic tumour activity on PET1 and its relative change on PET2 (Table S1, supporting information).…”

FDG-PET/CT lymph node staging after neoadjuvant chemotherapy in patients with adenocarcinoma of the esophageal–gastric junction

“…Patients received three preoperative and three postoperative cycles of chemotherapy, with surgery performed 3–6 weeks after completing the third cycle. Intravenous chemotherapy consisted of epirubicin (50 mg/m 2 ) and cisplatin (60 mg/m 2 ) with hydration and standard antiemetic prophylaxis on day 1 plus continuous infusion of fluorouracil (200 mg/m 2 daily) for 21 days (ECF) using a portable infusion pump or oral capecitabine (1.000 mg/m 2 twice daily) for 14 days (ECCap) in a 21 days cycle (according to the MAGIC regimen) [ 20 , 21 ]. Depending on the localization and extent of the tumor, all patients underwent either transthoracic esophagectomy with gastric pull-up reconstruction and intrathoracic esophagogastric anastomosis (Ivor–Lewis procedure), or proximally extended total or proximal gastrectomy with transhiatal resection of the distal esophagus and suprahiatal anastomosis.…”