Evaluation of Tumor Resectability Rate and Pathologic Response to Preoperative Concurrent Chemoradiotherapy in Locally Advanced Proximal Gastric and Esophagogastric Junction Adenocarcinomas: A Clinical Trial

Preoperative concurrent chemoradiotherapy may improve surgical results and patient survival rates in gastric adenocarcinomas. We aimed to assess tumor resectability and pathologic response rates in patients with locally advanced proximal gastric and esophagogastric junction adenocarcinomas by preoperative CRT and toxicity evaluation of treatment.
The patients with proximal gastric or esophagogastric junction adenocarcinoma who had locally advanced disease on basis of endoscopic and imaging findings were candidates for preoperative concurrent chemoradiotherapy. Eligible patients underwent radiotherapy 45-50.4/1.8-2 Grays, five days in week concurrent with chemotherapy by 5-fluorouracil and leucovorin or capecitabine. 4 - 6 weeks after completion of this treatment, non-metastatic patients underwent surgery and all resected specimens evaluated for completeness of resection and pathologic response rate of tumor to preoperative treatment. The patients were followed for postoperative complications in a short time.
35 out of 41 enrolled patients completed preoperative treatment without any mortality and significant toxicity. Ultimately, 22 patients underwent surgery. From these, 2 (9%) had unresectable tumors, 2 (9%) underwent incomplete resection and 18 (82%) completely resected. In pathologic evaluations, 52% showed complete and partial pathologic responses and 48% showed no pathologic response to preoperative treatments. Male gender was significantly associated with tumor pathologic response (P value = 0.034). Postoperative complications were seen in only two patients.
Preoperative concurrent chemoradiotherapy with 5 fluorouracil and leucovorin or capecitabine followed by surgery is a tolerable and safe treatment in patients with locally advanced proximal gastric and EGJ adenocarcinomas. It resulted in promising high rates of tumor resectability and pathologic response.