Metastatic Gastroesophageal Adenocarcinoma Patients Treated with Systemic Therapy Followed by Consolidative Local Therapy: A Nomogram Associated with Long-Term Survivors

• Published in: Oncology Vol. 91; no. 1; p. 55
• Main Authors: Shiozaki, Hironori, Slack, Rebecca S, Chen, Hsiang-Chun, Elimova, Elena, Planjery, Venkatram, Charalampakis, Nick, Wadhwa, Roopma, Shimodaira, Yusuke, Skinner, Heath, Lee, Jeffrey H, Weston, Brian, Bhutani, Manoop S, Blum-Murphy, Mariela, Rogers, Jane E, Maru, Dipen M, Matamoros, Jr, Aurelio, Sagebiel, Tara, Estrella, Jeannelyn S, Das, Prajnan, Hofstetter, Wayne L, Mares, Jeannette E, Mizrak Kaya, Dilsa, Harada, Kazuto, Lin, Quan, Minsky, Bruce D, Badgwell, Brian D, Ajani, Jaffer A
• Format: Journal Article
• Language: English
• Published: Switzerland 01.01.2016
• Subjects: Adult; Aged; Antineoplastic Combined Chemotherapy Protocols - therapeutic use; Esophageal Neoplasms - drug therapy; Esophageal Neoplasms - pathology; Esophageal Neoplasms - radiotherapy; Esophagogastric Junction - pathology; Female; Humans; Male; Middle Aged; Neoplasm Metastasis; Nomograms; Organoplatinum Compounds - administration & dosage; Pyrimidines - administration & dosage; Retrospective Studies; Stomach Neoplasms - drug therapy; Stomach Neoplasms - pathology; Stomach Neoplasms - radiotherapy; Survivors; Taxoids - administration & dosage
• ISSN: 1423-0232
• DOI: 10.1159/000445998

Patients with metastatic gastroesophageal adenocarcinoma (MGEAC) have a poor but heterogeneous clinical course. Some patients have an unusually favorable outcome. We sought to identify clinical variables associated with more favorable outcomes. Of 246 patients with MGEAC, we identified 64 who received systemic therapy and eventually received local consolidation therapy. Univariate and multivariate Cox regression models were used, and a nomogram was developed. Of these 64 patients, 61% had received consolidation chemoradiation (CRT) with doses of 50-55 Gy and 78% did not undergo surgery. The median follow-up time of survivors was 3.9 years, and the median overall survival (OS) from CRT start was 1.5 years (95% CI, 1.2-2.2). Surgery (as local consolidation) was an independent prognosticator for longer OS in the multivariate analysis (p = 0.02). The 5-year OS rate was 25% (SE = 6%). The contributors to the nomogram were longer duration of systemic therapy before CRT and the type of local therapy. Our data suggest that a subset of patients with MGEAC have an excellent prognosis (OS >5 years). However, these patients need to be identified during their clinical course so that local consolidation (CRT, surgery, or both) may be offered.