Adenocarcinoma of the Gastroesophageal Junction: Preoperative Cisplatin and Concomitant Continuous Infusion 5-Fluorouracil and Radiation Therapy

Abstract

The results of multimodal approaches to esophageal carcinoma suggest an improved patient outcome as compared with historical patients (Poplin et al. 1987). Adenocarcinomas of the gastroesophageal junction (GEJ) are often included in multimodal reports. However, the different tumor histology, site of disease, and patient outcome suggest that these tumors should be considered separately (Fein et al. 1985; Mahoney and Condon 1987; Turnbull and Goodner 1969). We initiated a multimodal protocol for the treatment of adenocarcinomas involving the GEJ using a debulking course of cisplatin (CDDP) and 5- fluorouracil (5-FU) chemotherapy prior of two courses of concomitant chemotherapy with radiotherapy. The rationale for debulking chemotherapy included: a means to evaluate response to the chemotherapy alone, an attempt to reduce tumor burden and thus allow for improved oral intake and nutrition prior to beginning radiotherapy, and an attempt to reduce the tumor mass and improve tumor oxygenation prior to initiating radiotherapy.