PREOPERATIVE HIGH-DOSE RADIATION AND CHEMOTHERAPY IN ADENOCARCINOMA OF THE ESOPHAGUS AND ESOPHAGOGASTRIC JUNCTION

Background: Esophageal adenocarcinoma (EA) incidence is rising. Defini ng optimal management is essential because median survival after surge ry alone is only approximately 12 months. High-dose radiation (>5000 c Gy) and chemotherapy (HDRCT) preoperatively for patients with EA has n ot been fully investigated. We evaluated tumor response, resectability , and survival following HDRCT in patients with localized EA. Methods: Thirty patients with American Joint Committee on Cancer (AJCC) clinic al stage I or Il EA were prospectively treated with HDRCT. The treatme nt consisted of 60 Gy radiation at 2 Gy per fraction with concurrent i nfusional 5-fluorouracil (5-FU) and a bolus of mitomycin C followed by esophagogastrectomy. The range of follow-up was 7 to 69 months, with a median of 31 months. Results: Twenty of 30 patients (67%) received f ull-course HDRCT. Severe esophagitis precluded full-dose radiation in 10 patients. Three patients developed neutropenia and fever requiring admission to a hospital. Two patients died preoperatively of treatment -related complications. Nine patients were not explored. Eighteen pati ents were resected with curative intent; the remaining three had metas tatic disease at laparotomy. Seven of 18 resected patients (39%), or 7 /30 (23%) of all patients treated, had a pathologic complete response. There was one operative death. Overall local control was seen in 25/3 0 patients (83%). Median overall survivals for resected and for all pa tients were 23 and 13 months, respectively. Conclusions: Preoperative HDRCT in patients with EA results in encouraging local tumor response and local control. Overall survival, however, may not be improved, and the treatment-related mortality of 10% is higher than reported with s urgery alone or with preoperative chemotherapy.