The Impact of Preoperative Radiochemotherapy on Survival in Advanced Esophagogastric Junction Signet Ring Cell Adenocarcinoma

“…A therapeutic strategy that includes neoadjuvant radiochimioterapy should be implemented in clinical practice for the treatment of locally advanced esophagogastric junction adenocarcinomas (26,27).…”

Section: Discussionmentioning

confidence: 99%

Neoadjuvant Radiochemotherapy for Patients with Locally Advanced Esophagogastric Junction Adenocarcinoma

Marica¹,

Bîrlă²,

Marica³

et al. 2018

chr

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RezumatRadiochimioterapia (RCT) neoajuvantã reprezintã o modalitate de management acceptatã de multe centre în abordarea adenocarcinomului de joncåiune esogastricã (JEG) avansat local Scopul: Influenţa RCT neoadjuvante asupra rezultatelor postoperatorii imediate şi la distanţă la pacienţii cu adenocarcinoame de JEG avansate local. Metoda: În Centrul de Excelenţă în Chirurgia Esofagiană de la Spitalul Sfânta Maria între 2010-2017 au fost trataţi 62 pacienţi cu adenocarcinoame de JEG avansate local. Conform clasificării Siewert şi Stein lotul a cuprins tipul I -11 pacienţi, tipul II -18 pacienţi şi tipul III -33 pacienţi. Radichimioterapie neoadjuvantă au efectuat 17 pacienţi. Tratamentul chirurgical la cei 62 de pacienţi rezecaţi a fost: esogastrectomie totală pe cale abdominală -40 pacienţi, esofagectomie subtotală cu rezecţia micii curburi gastrice -13 pacienţi, esofagectomie subtotală prin triplu abord McKeown -5 pacienţi şi esofagectomie abdomino-cervicală Orringer -4 pacienţi. Rezultate: Morbiditatea postoperatorie a fost de 46,77% şi a fost reprezentată în principal de fistule la 17 pacienţi şi complicaţii pulmonare de tipul pleureziilor, pneumoniilor si sindromului de detresă respiratorie la 12 pacienţi. S-au constatat fistule la 15 pacienţi: gradul 1 -2 pacienţi, gradul 2 -10 pacienţi, gradul 3-5 pacienţi. Mortalitatea postoperatorie a fost de 4.8%. (p_value = 0.017980 Fisher's Exact Test). Regresia stadiului iniţial s-a intâlnit

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“…Neoadjuvant CRT yields a higher rate of pathologic complete response than chemotherapy [34]. Moreover, CRT was the only independent favorable prognostic factor in a setting of locally advanced SRC EGJ tumors [35]. That said, the available data are still insufficient; dedicated randomized trials or subgroup analyses stratified according to tumor histology are needed.…”

Section: Egj Signet Ring Cell Carcinomasmentioning

confidence: 99%

“…Considering the limited extent of the disease in these cases, preoperative therapies-burdened by negligible morbidity-could represent overtreatment. Despite these considerations, there has been a tendency in more recent years to treat a greater number of cT2N0 patients with multimodal neoadjuvant approaches [35], given that it reportedly yields better biological control of the disease (6-18% of cT2N0 patients treated with multimodal therapy were pathologic complete responders) and a higher rate of radical resection [36][37][38]. However, any observed advantage in terms of overall and disease-free survival comes from comparing multimodality therapy with surgery alone in this clinical setting [36][37][38].…”

Section: Clinical T2n0 Tumorsmentioning

confidence: 99%

Western strategy for EGJ carcinoma

et al. 2016

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In this paper, the epidemiological and clinicobiological behavior of esophagogastric junction (EGJ) adenocarcinoma in the West is compared and contrasted to that in the East, and an overview is provided of current therapeutic strategies employed for this type of tumor in Western countries. It is well known that multimodal treatment is the therapeutic standard in locally advanced EGJ adenocarcinoma, but whether neoadjuvant/perioperative chemotherapy (CT) or neoadjuvant chemoradiotherapy (CRT) is the optimal approach is still debated. Neoadjuvant CRT improves local control in locally advanced Siewert type I and II tumors, so it should be considered the treatment of choice. In the subset of these patients with microscopic systemic disease at diagnosis, more intensive exclusive chemotherapy protocols could be of benefit. Therefore, there is an urgent need to identify these patients before planning the treatment. For Siewert type III tumors, perioperative chemotherapy is the standard. While there is general agreement on the optimal surgical approach for Siewert types I and III (a two-field Ivor Lewis operation and a total gastrectomy with distal esophagectomy, respectively), no standard surgical treatment has been defined for Siewert type II tumors. When data from Western series on proximal and circumferential resection margins and on nodal spread in Siewert type II tumors are taken into account, the optimal surgical approach appears to be Ivor Lewis esophagectomy. Whether the extent of esophageal invasion can correctly predict nodal involvement in middle-upper mediastinal stations as a means to restrict indications for transthoracic esophagectomy requires further investigation in the West.

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The Impact of Preoperative Radiochemotherapy on Survival in Advanced Esophagogastric Junction Signet Ring Cell Adenocarcinoma

Cited by 33 publications

References 12 publications

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Subdermal Contraceptive Implant Embolism to a Pulmonary Artery

Neoadjuvant Radiochemotherapy for Patients with Locally Advanced Esophagogastric Junction Adenocarcinoma

Western strategy for EGJ carcinoma

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