Neoadjuvant radio-chemotherapy of adeno-carcinoma of the oesophagogastric junction

Background: Recently, neoadjuvant radio-chemotherapy has been demonstrated to induce tumour remission and to prolong survival of patients with locally advanced adenocarcinoma of the oesophagogastric junction. The present stud y was performed to re-evaluate these data. Patients and Method: A non-rando mised trial of multimodal treatment was conducted in order to investigate h istopathologic response and survival of patients with adenocarcinoma of the oesophagogastric junction. Treatment consisted of 2 courses of combined ch emotherapy with 15 mg/kg 5-fluorouracil on days 1-5 and 75 mg/m(2) cisplati n on day 8 and simultaneous radiation (40 Gy), and a second course starting on day 36, followed by surgery. Abdomino-thoracic oesophagectomy and syste matic 2-field lymphadenectomy were performed in patients with Barrett's car cinoma. D2-gastrectomy was performed in patients with type 2 or 3 cancer of the oesophagogastric junction according to the Siewert classification. Pro bability of survival was estimated using the Kaplan-Meier method. Results: 16 patients with a mean age of 57 years were enrolled in this study. Surger y was performed in 14 of these patients. Response to treatment was evident in 10 patients, but none of these patients had complete histopathologic res ponse. Toxicity related to radiochemotherapy was mild to moderate (37.5%). Perioperative complications, both medical and surgical, occurred in 71.4% o f patients. 2 patients had fatal complications. 30-day mortality was 25.4%. The probability of survival at 2 years after surgery was 61.2%. Conclusion : Neoadjuvant radio-chemotherapy followed by surgery for cancer of the oeso phagogastric junction is associated with a considerable rate of complicatio ns. Histopathologic response to radio-chemotherapy is poor. In consequence of these preliminary results, the present study was terminated and the prot ocol of a future study was modified.