Multimodal Therapy of GEJ Cancer: When is the Definitive Radiochemotherapy the Treatment of Choice?
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 un
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Abstract
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.
Contents 1 Introduction.......................................................................................................................... 182 2 Standard Treatment Options in Localized Disease ............................................................ 182 2.1 Perioperative Therapy ................................................................................................ 182 2.2 Definitive Chemoradiotherapy ................................................................................... 182 3 Conclusion ........................................................................................................................... 184 References.................................................................................................................................. 184
M. Stahl (&) Department of Medical Oncology and Hematology, Kliniken Essen-Mitte, Henricistr 92, 45136 Essen, Germany e-mail: [email protected] F. Otto and M. P. Lutz (eds.), Early Gastrointestinal Cancers, Recent Results in Cancer Research 196, DOI: 10.1007/978-3-642-31629-6_12, Ó Springer-Verlag Berlin Heidelberg 2012
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M. Stahl
Introduction
Adenocarcinomas (AC) of the gastro-esophageal junction (GEJ) reflect a tumor entity with aggressive biology. In the Western countries, most of the patients present with advanced tumor stage at time of diagnosis. In this situation, the prognosis is poor and a minority of patients will survive 3 years even after complete primary tumor resection in experienced centers (Pyre et al. 2008). Among other reasons this comes from the fact that most of the locally advanced tumors (T3–T4 category) have spread to regional lymph nodes. Interestingly, even in lymph node negative tumors, the risk of systemic recurrence increases with Tcategory rising up to 70 % in completely resected pT3pN0 tumors (Pyre et al. 2008).
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Standard Treatment Options in Localized Disease
2.1
Peri
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