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.
This is a preview of subscription content, log in via an institution.
Buying options
Tax calculation will be finalised at checkout
Purchases are for personal use only
Learn about institutional subscriptionsReferences
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 25:1160–1168
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 9:794–802
Fiorica F, Di Bona D, Schepis F et al (2004) Preoperative chemoradiotherapy for oesophageal cancer: a systematic review and meta-analysis. Gut 53:925–930
Gebski V, Burmeister B, Smithers B et al (2007) Survival benefits from neoadjuvant chemoradiotherapy or chemotherapy in oesophageal carcinoma: a meta-analysis. Lancet Oncol 8:226–234
Greer S, Goodney P, Sutton J et al (2005) Neoadjuvant chemoradiotherapy for esophageal carcinoma: a meta-analysis. Surgery 137:172–177
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 347:1662–1669
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 98:768–783
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 2:35–52
Möhler M, Al-Batran S, Andus T et al (2011) German S3-guideline “diagnosis and treatment esophagogastric cancer”. Z Gastroenterol 49:461–531
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 248:549–556
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 83
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 23:2310–2317
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–v49
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 6
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 185:538–543
Author information
Authors and Affiliations
Corresponding author
Editor information
Editors and Affiliations
Rights and permissions
Copyright information
© 2012 Springer-Verlag Berlin Heidelberg
About this paper
Cite this paper
Stahl, M. (2012). Multimodal Therapy of GEJ Cancer: When is the Definitive Radiochemotherapy the Treatment of Choice?. In: Otto, F., Lutz, M. (eds) Early Gastrointestinal Cancers. Recent Results in Cancer Research, vol 196. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-642-31629-6_12
Download citation
DOI: https://doi.org/10.1007/978-3-642-31629-6_12
Published:
Publisher Name: Springer, Berlin, Heidelberg
Print ISBN: 978-3-642-31628-9
Online ISBN: 978-3-642-31629-6
eBook Packages: MedicineMedicine (R0)