Siewert Ⅱ和Ⅲ型食管胃结合部腺癌术前受累野照射同期放化疗生存分析

doi:10.3760/cma.j.issn.1004-4221.2018.07.005

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Abstract Objective To analyze the clinical efficacy,toxicity and survival prognosis of patients diagnosed with Siewert type Ⅱ and Ⅲ locally advanced adenocarcinoma of esophagogastric junction (AEG) undergoing preoperative involved-field irradiation with concurrent chemotherapy. Methods A total of 45 cases were recruited in this prospective clinical trial. Prior to surgery,patients received 2 cycles of chemotherapy with XELOX and concurrent radiotherapy (a total of 45 Gy in 25 fractions,5 times weekly).After 6-8 weeks,they underwent surgical resection. After the surgery,patients received 6 cycles of adjuvant chemotherapy. The completion of preoperative neoadjuvant chemoradiotherapy,postoperative pathological status,TNM down-staging effect and adverse reactions were observed. Kaplan-Meier method was applied to estimate survival analysis. Results All 45 patients completed preoperative neoadjuvant chemoradiotherapy. Among them,39 patients completed 2 cycles of chemotherapy,and 6 patients completed 1 cycle of chemotherapy. The median time of surgical interval was 6 weeks. The R0 resection rate was 96%.The pathological complete response (pCR) rate was 22%. The TNM down-staging rate was 69%.The incidence of acute radiation-induced esophagitis or gastritis was 44% and the incidence of radiation-induced pneumonitis was 7%. The incidence of grade 1-3 leukocytopenia,thrombocytopenia and neutropenia was 78%,47% and 44%,respectively. In terms of gastrointestinal reactions,the incidence of nausea,vomiting and loss of appetite was 62%,24% and 71%,respectively. No hematologic or nonhematologic adverse effects was observed at grade 4 or 5.The median follow-up time was 30 months.11 patients died of cancer,1 patient was treatment-related death in the perioperative period and 1 patient died of pneumonia.The 1-,2-and 3-year progression-free survival (PFS) rates were 90%,70% and 67%,respectively.The 1-,2-and 3-year overall survival rates were 95%,80% and 75%,respectively. The 1-,2-and 3-year local control rates were 95%,84% and 84%,respectively. The 1-,2-and 3-year distant metastasis rates were 7%,25% and 25%,respectively. Conclusions Preoperative involved-field irradiation with concurrent chemotherapy yields relatively high clinical efficacy and is well tolerated by patients with Siewert type Ⅱ and Ⅲ locally advanced AEG.Patients are recommended to receive 4 cycles of adjuvant chemotherapy following neoadjuvant chemoradiotherapy and surgery.

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	Articles by authors
	Huang Xin
	Wang Jun
	Zhao Qun
	Cheng Yunjie
	Tian Yuan
	Wang Yi
	Cao Feng
	Jing Shaowu
	Jiao Wenpeng
	Wu Yajing

Key words： Adenocarcinoma of esophagogastric junction/radiotherapy Adenocarcinoma of esophagogastric junction/chemotherapy Prognosis Drug tolerance

Received: 20 March 2017

Fund:Beijing Hope Run Special Fund of Cancer Foundation of China (LC2016W10);Hebei Medical Application Technology Project (GL201633);Key Project of Medical Science Research of Hebei Provincial Health Bureau (ZD20140060)

Corresponding Authors: Wang Jun,Email:wangjunzr@163.com;Zhao Qun,Email:zhaoqun516@126.com

Cite this article:

Huang Xin,Wang Jun,Zhao Qun et al. Survival analysis of preoperative involved-field irradiation with concurrent chemotherapy for patients with Siewert′s type Ⅱ and Ⅲ adenocarcinoma of esophagogastric junction[J]. Chinese Journal of Radiation Oncology, 2018, 27(7): 649-655.

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http://journal12.magtechjournal.com/Jweb_fszlx/EN/10.3760/cma.j.issn.1004-4221.2018.07.005 OR http://journal12.magtechjournal.com/Jweb_fszlx/EN/Y2018/V27/I7/649

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