Adjuvant (cisplatin, etoposide, and 5-fluorouracil) chemotherapy after curative resection of gastric adenocarcinomas involving the esophagogastric junction

Gastric adenocarcinomas involving the esophagogastric junction represent a particular therapeutic problem because they lie in the border area between two body cavities: the thorax and the abdomen. The prognosis of gastric ade nocarcinomas involving esophagogastric junction is poor because there is wi despread lymphatic metastasis, making curative resection difficult. Even in patients with localized disease who are potentially curable, the 5-year su rvival rate is similar to 20% with curative resection only, somewhat lower than for those with cancer elsewhere in the stomach. The authors conducted a pilot study to evaluate the safety and possible efficacy of adjuvant chem otherapy with cisplatin, etoposide, and 5-fluorouracil (PEF) after curative resection of gastric adenocarcinoma involving esophagogastric junction. Th ree cycles of adjuvant PEF chemotherapy with cisplatin (20 mg/m(2)/day intr avenously on days 1-5), etoposide (100 mg/m(2)/day intravenously on days 1, 3, and 5), and 5-fluorouracil (800 mg/m(2)/day continuous intravenous infu sion on days 1-5) were given every 3 weeks after curative resection of gast ric adenocarcinoma involving the esophagogastric junction. Between November 1989 and June 1995, a total of 50 patients with postoperative stage II, II IA, or IIIB disease entered this trial. In 14 of 50 patients (28%), the dis ease recurred during the follow-up of 4-83 months (median 26 months). Disea se-free survival was 4-83+ months (median 48 months), and the actuarial 5-y ear disease-free survival rate was 48% (95% CI: 41% to 55%). Overall surviv al was 4-83+ months (median 62 months), and the actuarial 5-year survival r ate was 54% (95% CI: 40% to 68%). The prognostic factor analysis showed tha t the postoperative N stage and the interval between surgery and chemothera py affected disease-free survival and overall survival. The toxicities of P EF adjuvant chemotherapy were leukopenia, nausea/vomiting, and alopecia, bu t they were mostly mild and reversible except in one patient who died becau se of treatment-related sepsis. Adjuvant chemotherapy with three cycles of PEF regimen was well tolerated and seems to be a promising treatment for ga stric adenocarcinoma involving the esophagopstric junction, in comparison w ith previous treatments. To define the efficacy of adjuvant PEF chemotherap y for gastric adenocarcinoma involving esophagogastric junction, prospectiv e randomized trials are warranted.