Open AccessLocally Advanced Gastroesophageal Junction Tumor: A Treatment Dilemma
Author(s) -
Ashraf Noman,
Hoffe Sarah,
Kim Richard
Publication year - 2015
Publication title -
the oncologist
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.176
H-Index - 164
eISSN - 1549-490X
pISSN - 1083-7159
DOI - 10.1634/theoncologist.2014-0377
Subject(s) - medicine , gastroesophageal junction , radiation therapy , disease , chemoradiotherapy , perioperative , multimodal therapy , clinical trial , adenocarcinoma , dilemma , general surgery , intensive care medicine , surgery , cancer , philosophy , epistemology
Over the last several decades, the incidence of adenocarcinoma of the gastroesophageal junction (GEJ) has been increasing in developed countries. Although complete surgical resection remains the cornerstone of treatment for resectable disease, long‐term outcomes are poor and recurrence rates are high with surgery alone in patients presenting with locally advanced disease. Multimodal therapy has been shown to improve survival; however, the optimal therapeutic approach remains controversial, and practices vary across the world. Preoperative chemoradiotherapy is generally used in the U.S., whereas perioperative chemotherapy without radiation is favored in most European countries. In this review, we discuss why the treatment of locally advanced GEJ tumors remains controversial, examine the evidence for various multimodal approaches, discuss their respective pros and cons, evaluate the role of radiation therapy, highlight some ongoing and planned clinical trials, and suggest areas that need further research.