Definitive Chemoradiation for Gastroesophageal junction (GEJ) Adenocarcinomas: A Single-Institution Experience

Background and Objectives: The non-surgical treatment outcome of gastroesophageal junction (GEJ) adenocarcinoma remains to be defined. We aimed to assess the outcomes of definitive chemoradiation (CRT) of GEJ tumors. Methods: In this retrospective cohort, we evaluated 50 patients with non-metastatic adenocarcinoma of GEJ (Siewert's type I and II) treated by chemoradiation without surgery from 2008 to 2017. The reasons for not undergoing surgery were patient refusal, medical unfitness, de novo metastasis in pre-op restaging, and tumor unresectability or progress at the time of operation. The primary outcome was overall survival; secondary outcomes were progression-free survival and local and distal recurrence. Results: The 1-year, 2-year, and 3-year overall survival rates were 53%, 26%, and 12%, respectively. The 1-year, 2-year, and 3-year progression-free survival rates were 44%, 18%, and 10%, respectively. The univariate Cox regression analysis with log-rank test showed that age group and the reason for not undergoing surgery, histologic grade, radiotherapy duration, and distant recurrence had an almost significant association with overall survival. However, after multivariate analysis, the only independent predictor of survival was a distant failure (P=0.031). Conclusion: Although the outcomes of non-surgical treatments are disappointing in GEJ adenocarcinomas, a few patients may experience long-term survival using definitive CRT. This option should be discussed with all patients who are not candidates for surgery.