Today, patients with localized gastroesophageal junction adenocarcinomas (AC) should be considered for combined modality therapy, at least when they have locally advanced (T3–T4 category) or lymph node positive tumors. But what about patients unable or unwilling to undergo surgical resection? Unlike esophageal squamous cell carcinoma (SCC), we have no randomized data to consider definitive radiochemotherapy without surgery as accepted treatment option in these patients. Retrospective results from an US surveillance epidemiology and end results (SEER) analysis state that the results of definitive or preoperative radio(chemo)therapy are equal or even improved for adenocarcinoma compared to SCC. Other retrospective data using the method of matched-pair analysis showed that median overall survival appears not different between AC and SCC after definitive radiochemotherapy. Nevertheless, since prospective randomized results are lacking, definitive radiochemotherapy cannot be considered as treatment standard in GEJ cancer, and therefore should be restricted to patients with increased operation risk.
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.
This is a preview of subscription content, log in to check access.
Bedenne L, Michel P, Bouche O et al (2007) Chemoradiation followed by surgery compared with chemoradiation alone in squamous cancer of the esophagus: FFCD 9102. J Clin Oncol 25:1160–1168PubMedCrossRefGoogle Scholar
Chiu PW, Chan AC, Leung SF et al (2005) Multicenter prospective randomized trial comparing standard esophagectomy with chemoradiotherapy for treatment of squamous esophageal cancer: early results from the Chinese University Research Group for Esophageal Cancer (CURE). J Gastrointest Surg 9:794–802PubMedCrossRefGoogle Scholar
Fiorica F, Di Bona D, Schepis F et al (2004) Preoperative chemoradiotherapy for oesophageal cancer: a systematic review and meta-analysis. Gut 53:925–930PubMedCrossRefGoogle Scholar
Gebski V, Burmeister B, Smithers B et al (2007) Survival benefits from neoadjuvant chemoradiotherapy or chemotherapy in oesophageal carcinoma: a meta-analysis. Lancet Oncol 8:226–234PubMedCrossRefGoogle Scholar
Greer S, Goodney P, Sutton J et al (2005) Neoadjuvant chemoradiotherapy for esophageal carcinoma: a meta-analysis. Surgery 137:172–177PubMedCrossRefGoogle Scholar
Hulscher J, van Sandick J, de Boer A et al (2002) Extended transthoracic resection compared with limited transhiatal resection for adenocarcinoma of the esophagus. N Engl J Med 347:1662–1669PubMedCrossRefGoogle Scholar
Kranzfelder M, Schuster T, Geinitz H et al (2011) Meta-analysis of neoadjuvant treatment modalities and definitive non-surgical therapy for oesophageal squamous cell cancer. Br J Surg 98:768–783PubMedCrossRefGoogle Scholar
Malthaner R, Wong R, Rumble R et al (2004) Neoadjuvant or adjuvant therapy for resectable esophageal cancer: a systematic review and meta-analysis. BMC Med 2:35–52PubMedCrossRefGoogle Scholar
Möhler M, Al-Batran S, Andus T et al (2011) German S3-guideline “diagnosis and treatment esophagogastric cancer”. Z Gastroenterol 49:461–531CrossRefGoogle Scholar
Peyre C, Hagen J, DeMeester S et al (2008) The number of lymph nodes removed predicts survival in esophageal cancer: an international study on the impact of extent of surgical resection. Ann Surg 248:549–556PubMedCrossRefGoogle Scholar
Smit JK, Muijs CT, Paul R et al. (2012) Definitive (chemo)radiotherapy in patients with esophageal cancer: a population-based study in northeast Netherlands. J Clin Oncol 30(suppl. 4), abstract 83Google Scholar
Stahl M, Stuschke M, Lehmann N et al (2005) Chemoradiation with and without surgery in patients with squamous cell carcinoma of the esophagus. J Clin Oncol 23:2310–2317PubMedCrossRefGoogle Scholar
Stahl M, Budach W, Meyer HJ, Cervantes A (2010) Esophageal cancer: clinical recommendations for diagnosis, treatment and follow-up. Ann Oncol 21(suppl 5):v46–v49PubMedCrossRefGoogle Scholar
Taketa T, Correa AM, Suzuki A et al. (2012) Outcome of trimodality-eligible esophago-gastric cancer patients who declined surgery after preoperative chemoradiation. J Clin Oncol 30(suppl. 4), abstract 6Google Scholar
Urschel J, Vasan H (2002) A meta-analysis of randomized controlled trials that compared neoadjuvant chemoradiation and surgery to surgery alone for resectable esophageal cancer. Am J Surg 185:538–543CrossRefGoogle Scholar