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Comparative Effectiveness in Esophagogastric Cancer

Chapter
First Online:
Part of the Cancer Treatment and Research book series (CTAR, volume 164)

Abstract

Cancer of the esophagus and the gastroesophageal junction (GEJ) continues to have a dismal prognosis, with the incidence of esophageal cancer increasing in the United States. Although radical resection was initially the primary treatment for this disease process, systemic chemotherapy and radiation have been shown to play a role in prolonging survival in most patient populations. This chapter explores the evidence that guides treatment for esophageal and GEJ cancer today. Chemotherapy and radiation therapy were introduced as treatment modalities for esophageal and GEJ cancers when it became evident that surgical therapy alone provided poor long-term survival rates. A variety of treatment strategies have been explored including preoperative (neoadjuvant) and postoperative (adjuvant) chemotherapy, with and without radiation. The evidence suggests that neoadjuvant chemotherapy or chemoradiotherapy provides better outcomes compared to surgery alone for esophageal, GEJ, and gastric cancers. Studies indicate a trend towards improved survival when neoadjuvant chemoradiotherapy is compared to chemotherapy alone. When patients have undergone resection with node-positive disease without receiving neoadjuvant therapy, some form of adjuvant treatment is recommended. This chapter also explores the surgical management of esophageal, GEJ, and gastric cancers including the extent of the gastric lymph node dissection. It also includes a discussion about adherence to national guidelines in terms of gastric cancer treatment and esophageal and gastric lymph node examinations.

Keywords

Gastric Cancer Esophageal Cancer National Comprehensive Cancer Network Comparative Effectiveness Research Gastric Conduit 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.
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Copyright information

© Springer International Publishing Switzerland 2015

Authors and Affiliations

  1. 1.Division of Surgical Oncology, Department of SurgeryNorthwestern UniversityChicagoUSA
  2. 2.Division of Hematology/Oncology, Department of Medicine, Feinberg School of MedicineNorthwestern UniversityChicagoUSA
  3. 3.Robert H. Lurie Comprehensive Cancer Center of Northwestern UniversityChicagoUSA
  4. 4.Jesse Brown VA Medical CenterChicagoUSA

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