Locally Advanced Gastro-Esophageal Junction Carcinoma- Evaluation Of Two Modalities Of Treatment At A Tertiary Care Center.

Introduction- The incidence of Gastroesophageal junction (GEJ) adenocarcinoma is increasing rapidly. Data separately on GEJ tumors management is rare. Objectives- to evaluate the clinicopathological characteristics of GEJ tumors, to compare two modalities of treatment- Neoadjuvant treatment followed by surgery(group-N) and upfront surgery(group-S) in GEJ tumors in terms of recurrence and survival. Materials and methods- Records of all the patients diagnosed and treated with curative intent as GEJ tumors as per Siewert classification, between 2005-2013 were reviewed. Patients of age above 18yrs, ECOG PS 0, 1, 2, clinical, radiological, endoscopic and histologically proven GEJ tumor limited loco-regionally were included. Kaplan-Meire graph utilized to calculate survival and recurrence pattern. Chi-square(X2) test used to assess association between clinico-pathological parameters and outcome. The comparison of survival and recurrence rate was computed by log rank test. Results- Among 68 eligible patients group-S were 43(63.2%) and group-N 25(36.8%). Predominant histology was adenocarcinoma (85?ch). Group-N received either neoadjuvant chemotherapy-19(76%) or concurrent chemoradiation-6(24%). Surgery in both groups was Ivor- Lewis 52(76.4%) or Minimally invasive Mckeowns 16(23.6%). Median follow-up period was 21months. In group-S, high grade tumors had worse survival (OS-grade III 20 months Vs grade I, II 36 months. p-0.015). No clinico-pathological factors affected outcome in group-N. In group-N 5/25(20%) had grade 3 toxicity. Severe postoperative complications occurred 10(23%) in group-S and 4(16%) in group-N. Group-N has higher DFI (17.5months) and OS (30.5 months) compared to group-S (DFI 14months; OS 21.5months) but without statistical significance (p-0.56 and p-0.83 respectively.) Conclusion- In our single institute study, improved recurrence free period and survival with neoadjuvant treatment over primary surgery group in the management of GEJ carcinoma is not reflected statistically. Further prospective randomized studies are required to assess the effect of neoadjuvant therapy in GEJ tumors. [ABSTRACT FROM AUTHOR]