Management of a 16-year-old boy with adenocarcinoma at the esophageal gastric junction

✍ Scribed by Zotter, Heinz ;Schwinger, Wolfgang ;Kerbl, Reinhold ;Urban, Christian ;Juettner, Freyja-Maria Smolle ;Hinterleitner, Thomas

• Publisher: John Wiley and Sons
• Year: 2001
• Tongue: English
• Weight: 35 KB
• Volume: 37
• Category: Article
• ISSN: 0098-1532
• DOI: 10.1002/mpo.1255

✦ Synopsis

To the Editor: Gastric carcinoma most frequently occurs in adults older than age 50 and is rare in children and adolescents [1,2]. Only a few cases of adenocarcinoma at the esophageal gastric junction in childhood have been reported so far, with poor survival [3±6]. Management in children is usually based on principles used in adults [7]. To our knowledge, only a 16-year-old girl with adenocarcinoma at the esophageal gastric junction is considered a survivor (disease-free followup of 30 months) [6]. Our experience with multiagent chemotherapy in such a patient is therefore of interest.

A 16-year-old boy presented with adenocarcinoma at the esophageal gastric junction. Because the tumor was considered to be unresectable, he was treated with repeated courses of intravenous chemotherapy consisting of methotrexate (total dose 24 g/m 2 ), ¯uorouracil (total dose 3,750 mg/m 2 ), cisplatin (total dose 320 mg/m 2 ), doxorubicin (60 mg/m 2 ), etoposide (450 mg/m 2 ), and paclitaxel (total dose 200 mg/m 2 ). Although neither single-agent chemotherapy nor combination of agents have yet proved to be of signi®cant bene®t [8±10], preoperative chemotherapy may have improved resectability in our patient. The paraaortic tissue, which initially had shown radiologic and macroscopic signs of in®ltration, was histologically free of disease after chemotherapy. Total en bloc esophagogastrectomy was performed and a cervical esophagojejunostomy with retrosternal placement of a pedicled jejunal loop and Roux-en-Y anastomosis was constructed. Histological analysis revealed a poorly differentiated adenocarcinoma with partial response to chemotherapy. Evaluation 16 months after surgery revealed no further evidence of disease.

Although carcinoma of the esophageal gastric junction is rare in children, it should be considered in any case of dysphagia, especially in adolescents. Surgical therapy is the method of choice, but preoperative chemotherapy may improve resectability in tumors not resectable per primum at the esophageal gastric junction.