Peri-operative chemotherapy versus preoperative chemoradiotherapy in treatment of gastro-oesophageal junctional adenocarcinomas: A 10-year cohort study

Ahmed Mohammed Elshaer; Manuk Wijeyaratne; S M Higgs; S T Hornby; S J Dwerryhouse

doi:10.1016/j.ejso.2023.107016

Peri-operative chemotherapy versus preoperative chemoradiotherapy in treatment of gastro-oesophageal junctional adenocarcinomas: A 10-year cohort study

Eur J Surg Oncol. 2023 Oct;49(10):107016. doi: 10.1016/j.ejso.2023.107016. Epub 2023 Aug 11.

Authors

Ahmed Mohammed Elshaer¹, Manuk Wijeyaratne², S M Higgs³, S T Hornby⁴, S J Dwerryhouse⁵

Affiliations

¹ Department of Upper Gastrointestinal Surgery, Gloucestershire Hospitals NHS Trust, Gloucester, United Kingdom; Cairo University Hospitals (Kasr-Alainy Hospital), Cairo, Egypt. Electronic address: ams872004@gmail.com.
² Department of Upper Gastrointestinal Surgery, Gloucestershire Hospitals NHS Trust, Gloucester, United Kingdom. Electronic address: manuk.wijeyaratne@nhs.net.
³ Department of Upper Gastrointestinal Surgery, Gloucestershire Hospitals NHS Trust, Gloucester, United Kingdom. Electronic address: s.higgs@nhs.net.
⁴ Department of Upper Gastrointestinal Surgery, Gloucestershire Hospitals NHS Trust, Gloucester, United Kingdom. Electronic address: steve.hornby@nhs.net.
⁵ Department of Upper Gastrointestinal Surgery, Gloucestershire Hospitals NHS Trust, Gloucester, United Kingdom. Electronic address: simondwerryhouse@nhs.net.

PMID: 37586127
DOI: 10.1016/j.ejso.2023.107016

Abstract

Background: Gastro-oesophageal junctional (GOJ) cancers have been, more latterly, considered a distinct tumor entity with characteristic genetic profiles. The optimal multimodal therapy of advanced GOJ cancers remains debatable. In this comparative study, we analyzed the outcomes of peri-operative chemotherapy (CT) versus pre-operative chemoradiotherapy (CRT) in treatment of advanced GOJ adenocarcinomas.

Methods: This study included patients with locally advanced but resectable GOJ adenocarcinomas who underwent surgical resection after oncological therapy between 2010 till 2019 at our institution. Follow up to May 2021 was completed. The outcomes between CT and CRT groups were retrospectively analyzed. The long-term follow up data was obtained via direct contact with the patients during oncological clinics, cross-checked with hospital/national patients' electronic databases.

Results: 107 patients had GOJ cancers; 90 (84%) patients met our inclusion criteria. Perioperative chemotherapy was administrated in 65 (72%) patients. Overall median survival rate was 2.2 years in CRT-group compared to 2.4 years in CT-group (p-value 0.29), with comparable recurrence rates (48% vs 36% respectively). R0-resections were higher in CRT-group (84%) compared to CT-group (71%), yet insignificant p-value 0.197. Preoperative chemoradiotherapy achieved higher complete pathological response (28% vs 6%, p-value 0.009) and negative lymph nodes rates (64% vs 37%, p-value 0.014) compared to CT-group. Short-term outcomes (postoperative complications, morbidity rates and length of hospital stay) were similar across both groups.

Conclusion: Preoperative chemoradiotherapy was associated with higher complete pathological response and negative lymph nodes rates for GOJ adenocarcinomas compared to peri-operative chemotherapy, without an increase in postoperative complications or morbidity rates. However, it wasn't associated with improved overall or disease-free survival rates.

Keywords: Chemoradiotherapy; Chemotherapy; Gastro-oesophageal cancers; Junctional tumours.