Survival benefit of neoadjuvant radiation therapy in patients with carcinoma of gastroesophageal junction and distal esophagus? A population-based study

Xiao-Lin Ge, Shu Liu, Hong-Cheng Zhu, Sohail Ahmed, Xi Yang, Ya-Qi Song, Qing Guo, Min Yang, Xin-Chen Sun


Background: The incidence of carcinoma of gastroesophageal junction (GEJ) and distal esophagus (DE) is growing globally and the standard treatment remained controversial. GEJ cancer is different from esophageal cancer (EC) and gastric cancer (GC) not only anatomically but also biologically. We aim to investigate the value of (neo)adjuvant radiotherapy (RT) in multidisciplinary treatment procedure of this disease.
Methods: Data for carcinoma of GEJ and DE were obtained from January 1973 to December 2012 from the US National Cancer Institute’s Surveillance, Epidemiology, and End Results (SEER) Program. Univariate and multivariate analyses were performed to examine the impact of race, gender, age, grade, histology, surgery, RT and other potential prognostic factors on overall survival (OS) and cancer-specific survival (CSS).
Results: Five hundred and sixteen patients with carcinoma of GEJ and DE in the SEER database were identified in this study. Of them 135 received either surgery or RT, 139 underwent surgery and
164 underwent RT alone, 41 had neoadjuvant RT with surgery and 37 had adjuvant RT with surgery. Gender, histological type, and treatment modalities are independent prognostic factors (P<0.05). Patients with carcinoma of GEJ and DE benefit from both surgery (P<0.001) and RT (P<0.001). Surgery alone is superior to RT alone (P<0.001) in both OS and CSS. In multidisciplinary treatment of carcinoma of GEJ and DE, preoperative RT is not superior to surgery alone, regardless of histological subtype. In patients with squamous cell carcinoma (SCC), postoperative RT adds no benefit (P=0.231) and preoperative RT is better than postoperative RT in improving OS (P=0.026).
Conclusions: Surgery is the primary choice for carcinoma of GEJ and DE while neoadjuvant RT is considerable in multidisciplinary treatment, especially in SCC. Special attention should be paid when thinking about conducting postoperative RT in SCC.