Summary
Multimodality therapy is the key to the treatment of carcinomas of the gastroesophageal junction. Chemoradiation followed by esophagectomy appears to be the standard therapy at the present time. Selected patients who respond completely to the chemotherapy and radiation are probably the best candidates for esophagectomy. Although extended lymph node dissection is advocated, there are not sufficient data to determine whether the increased morbidity of the procedure is justified by the improvement in outcome for junctional cancers. Early cancers in nonsurgical patients could potentially be treated by endoscopic methods including endoscopic mucosal resection, which permits accurate staging, and photodynamic therapy, which permits treatment of residual premalignant tissue. Palliation of patients with advanced cancers of the gastroesophageal junction is probably best managed with expandable metal stents, although there is some evidence to suggest that thermal methods of palliation may enhance the quality of life in these patients.
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References
Stein,HJ,Feith,M,Siewert,JR. Cancer of the esophagogastric junction. Surg Oncol 2000;9:35–41.
Falk,GW. Gastroesophageal reflux disease and Barrett’s esophagus. Endoscopy 2001;33:109–1 18.
El-Zimaity,HM,Ramchatesingh,J,Saeed,MA,Graham,DY. Gastric intestinal metaplasia: Subtypes and natural history. J Clin Pathol 2001;54:679–683.
Mark,SD,Qiao,YL,Dawsey,SM,Wu,YP,Katki,H,Gunter,EW,Fraumeni,JF Jr,Blot,WJ,Dong,ZW,Taylor,PR. Prospective study of serum selenium levels and incident esophageal and gastric cancers. J Natl Cancer Inst 2000;92:1753–1763.
Luketich,JD,Schauer,P,Urso,K,Kassis,E,Ferson,P,Keenan,R, Landreneau,R. Future directions in esophageal cancer. Chest 1998;113(Suppl 1):120S-122S.
Meltzer,CC,Luketich,JD,Friedman,D,Charron,M,Strollo,D,Meehan,M, Urso,GK,Dachille,MA,Townsend,DW. Whole-body FDG positron emission tomographic imaging for staging esophageal cancer comparison with computed tomography. Clin Nucl Med 2000;25:882–887.
Flamen,P,Lerut,A,Van Cutsem,E,Cambier,JP,Maes,A,De,Wever W,Peeters,M,De,Leyn P,Van,Raemdonck D,Mortelmans,L. The utility of positron emission tomography for the diagnosis and staging of recurrent esophageal cancer. J Thorac Cardiovasc Surg 2000;120:1085–1092.
Van Dam,J. Endosonographic evaluation of the patient with esophageal carcinoma. Chest Surg Clin North Am 1994;4:269–284.
Luketich,JD,Schauer,P,Landreneau,R,Nguyen,N,Urso,K,Ferson,P, Keenan,R,Kim,R. Minimally invasive surgical staging is superior to endoscopic ultrasound in detecting lymph node metastases in esophageal cancer. J Thorac Cardiovasc Surg 1997;114:817–823.
Korst,RJ,Rusch,VW,Venkatraman,E,Bains,MS,Burt,ME,Downey,RJ, Ginsberg,RJ. Proposed revision of the staging classification for esophageal cancer. J Thorac Cardiovasc Surg 1998;115:660–670.
Cooper,JS,Guo MD,Herskovic A, Macdonald JS, Martenson, JAJr, Al-Sarraf,M,Byhardt,R,Russell,AH,Beitler,JJ,Spencer,S,Asbell,SO, Graham,MV,Leichman,LL. Chemoradiotherapy of locally advanced esophageal cancer: Long-term followup of a prospective randomized trial (RTOG 85-01). Radiation Therapy Oncology Group. JAMA 1999;281:1623–1627.
Gaspar,LE,Winter,K,Kocha,WI,Coia,LR,Herskovic,A,Graham M. A phase I/II study of external beam radiation, brachytherapy, and concurrent chemotherapy for patients with localized carcinoma of the esophagus (Radiation Therapy Oncology Group Study 9207): Final report. Cancer, 2000;88:988–995.
KingTC,Estalilla,OC,Safran,H. Role of p53 and p16 gene alterations in determining response to concurrent paclitaxel and radiation in solid tumor. Semin Radiat Oncol 1999; 9(Suppl1):4–11.
Mattioli,S,D’Ovidio,F,Tazzari,P,Pilotti,V,Daddi,N,Bandini G,Piccioli,M,Pileri,S. Iliac crest biopsy versus rib segment resection for the detection of bone marrow isolated tumor cells from lung and esophageal cancer. Eur J Cardiothor Surg 2001;19:576–579.
GehJI,Crellin,AM,Glynne-Jones,R. Preoperative (neoadjuvant) chemoradiotherapy in oesophageal cancer. Br J Surg 2001;88:338–356.
Nygaard,K,Hagen,S,Hansen,HS,Hatlevoll,R,Hultborn,R,Jakobsen,A, Mantyla,M,Modig,H,Munck-Wikland,E,Rosengren,B. Preoperative radiotherapy prolongs survival in operable esophageal carcinoma: A randomized, multicenter study of pre-operative radiotherapy and chemotherapy. The second Scandinavian Trial in esophageal cancer. WorldJ Surg 1992; 16:1104–1110.
Le,Prise E,Etienne,PL,Meunier,B,Maddern,G,Ben,Hassel M,Gedouin,D,Boutin,D,Campion,JP,Launois,B. A randomized study of chemotherapy, radiation therapy, and surgery versus surgery for localized squamous cell carcinoma of the esophagus. Cancer 1994;73:1779–1784.
Apinop,C,Puttisak,P,Preecha,N. A prospective study of combined therapy in esophageal cancer. Hepatogastroenterology 1994;41:391–393.
Walsh,TN,Noonan,N,Hollywood,D,Kelly,A,Keeling,N,Hennessy,TP. A comparison of multimodal therapy and surgery for esophageal adenocarcinoma. N Engl J Med 1996;335:462–467.
BossetJF,GignouxM,Triboulet,JP,Tiret,E,Mantion,G,Elias,D,Lozach,P, Ollier,JC,PavyJJ,Mercier,M,Sahmoud,T. Chemoradiotherapy followed by surgery compared with surgery alone in squamous-cell cancer of the esophagus. N Engl J Med 1997;337:161–167.
Urba,S. Combined-modality treatment of esophageal cancer. Oncology (Huntingt) 1997; 11(9 Suppl 9):63–67.
Siewert,JR,Stein,HJ,Fink,U. Multimodality therapy for esophageal cancer. Oncologist 1996;1:210–218.
Green,RJ,Haller,DG. Neoadjuvant therapy for cancer of the esophagus. Cancer Control 1999;6:43–52.
Swanson,SJ,Batirel,HF,Bueno,R,Jaklitsch,MT,Lukanich,JM,Allred,E, Mentzer,SJ,Sugarbaker,DJ. Transthoracic esophagectomy with radical mediastinal and abdominal lymph node dissection and cervical esophagogastrostomy for esophageal carcinoma. Ann Thorac Surg 2001;72:1918–1924.
Chu,KM,Law,SY,FokM,Wong J. A prospective randomized comparison of transhiatal and transthoracic resection for lowerthird esophageal carcinoma. AmJ Surg 1997;174:320–324.
Lerut,T,Coosemans,W,De,Leyn P,Deneffe,G,Topal,B,Van de Ven C,Van Raemdonck,D. Reflections on three field lymphadenectomy in carcinoma of the esophagus and gastroesophageal junction. Hepatogastroenterology 1999;46:717–725.
Igaki,H,Kato,H,Tachimori,Y,Sato,H,Daiko,H,Nakanishi,Y. Prognostic evaluation for squamous cell carcinomas of the lower thoracic esophagus treated with three-field lymph node dissection. EuroJ Cardiothorac Surg 2001;19:887–893.
Dresner,SM,Griffin,SM. Pattern of recurrence following radical oesophagectomy with two-field lymphadenectomy. Br J Surg 2000;87:1426–1433.
Seto,Y,Nagawa,H,Muto,T. Treatment of multiple early gastric cancer. JpnJ Clin Oncol 1996;26:134–138.
Moreira,LF,Kamikawa,Y,Naomoto,Y,Haisa,M,Orita,K. Endoscopic mucosal resection for superficial carcinoma and high-grade dysplasia of the esophagus. Surg Laparosc Endosc 1995;5:171–175.
Yamamoto,H,Sekine,Y,Higashizawa,T,Kihira,K,Kaneko,Y,Hosoya,Y, Ido,K,Saito,K,Sugano,K. Successful en bloc resection of a large superficial gastric cancer by using sodium hyaluronate and electrocautery incision forceps. Gastrointest Endosc 2001;54:629–632.
Buttar,NS,Wang,KK,Lutzke,LS,Krishnadath,KK,Anderson MA. Combined endoscopic mucosal resection and photodynamic therapy for esophageal neoplasia within Barrett’s esophagus. Gastrointest Endosc 2001;54:682–688.
Etienne,J,Dorme,N,Bourg-Heckly,G,Raimbert,P,Fekete,F. Local curative treatment of superficial adenocarcinoma in Barrett’s esophagus. First results of photodynamic therapy with a new photosensitizer. Bull Acad Natl Med 2000;184:1731–1747.
Gossner,L,Stolte,M,Sroka,R,Rick,K,May,A,Hahn,EG,Ell,C. Photodynamic ablation of high-grade dysplasia and early cancer in Barrett’s esophagus by means of 5-aminolevulinic acid. Gastroenterology 1998;114:448–455.
PanjehpourM,Overholt,BF,HaydekJM,Lee,SG. Results of photodynamic therapy for ablation of dysplasia and early cancer in Barrett’s esophagus and effect of oral steroids on stricture formation. AmJ Gastroenterol 2000;95:2177–2184.
Sibille,A,Lambert,R,Souquet,JC,Sabbeu,G,Descos,F. Long-term survival after photodynamics therapy for esophageal cancer. Gastroenterology 1995;108:337–344.
Narayan,S,Sivak,MV Jr. Palliation of esophageal carcinoma. Laser and photodynamic therapy. Chest Surg Clin North Am 1994;4:347–367.
Kozarek,RA,Ball,TJ,Brandabur,JJ,Patterson,DJ,Low,D,Hill, L,Raltz,S. Expandable versus conventional esophageal prostheses: Easier insertion may not preclude subsequent stentrelated problems. Gastrointest Endosc 1996;43:204–208.
Dallal,HJ,Smith,GD,Grieve,DC,Ghosh,S,Penman,ID,Palmer,KR. A randomized trial of thermal ablative therapy versus expandable metal stents in the palliative treatment of patients with esophageal carcinoma. Gastrointest Endosc 2001;54:549–557.
Konigsrainer,A,Riedmann,B,De Vries,A,Ofner,D,Spechtenhauser,B,Aigner,F,Fritsch,E,Margreiter,R. Expandable metal stents versus laser combined with radiotherapy for palliation of unresectable esophageal cancer: A prospective randomized trial. Hepatogastroenterology 2000; 47:724–727.
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Supported by National Institutes of Health grants CA85992-01 and CA78870-01 and by the Mayo Foundation.
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Wang, K.K. Multimodality therapy for gastroesophageal cancers. J Gastrointest Surg 6, 527–531 (2002). https://doi.org/10.1016/S1091-255X(02)00027-6
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DOI: https://doi.org/10.1016/S1091-255X(02)00027-6