Esophageal cancer is the sixth most common cause of cancer deaths worldwide. Adenocarcinoma is more common in North America and Western European countries, originating mostly in the lower third of the esophagus, which often involves the esophagogastric junction (EGJ). Recent randomized trials have shown that the addition of preoperative chemoradiation or perioperative chemotherapy to surgery significantly improves survival in patients with resectable cancer. Targeted therapies with trastuzumab and ramucirumab have produced encouraging results in the treatment of advanced or metastatic EGJ adenocarcinomas. Multidisciplinary team management is essential for patients with esophageal and EGJ cancers. This portion of the NCCN Guidelines for Esophageal and EGJ Cancers discusses management of locally advanced adenocarcinoma of the esophagus and EGJ.

The NCCN Clinical Practice Guidelines in Oncology for Gastric Cancer provide evidence-and consensus-based recommendations for a multidisciplinary approach for the management of patients with gastric cancer. For patients with resectable locoregional cancer, the guidelines recommend gastrectomy with a D1+ or a modified D2 lymph node dissection (performed by experienced surgeons in highvolume centers). Postoperative chemoradiation is the preferred option after complete gastric resection for patients with T3-T4 tumors and node-positive T1-T2 tumors. Postoperative chemotherapy is included as an option after a modified D2 lymph node dissection for this group of patients. Trastuzumab with chemotherapy is recommended as first-line therapy for patients with HER2-positive advanced or metastatic cancer, confirmed by immunohistochemistry and, if needed, by fluorescence in situ hybridization for IHC

When managing nonseminomatous germ cell tumors, contralateral lung abnormalities ≤ 10 mm can be observed if histology of unilateral PM demonstrates complete tumor necrosis. 17. When managing nonseminomatous germ cell tumors, PM is indicated for select patients with limited number of lung abnormalities after first or second-line platin-based chemotherapy suspected of containing viable nonseminomatous cancer and/or malignant transformation of teratoma into non-germ cell cancer. 18. In breast cancer patients, PM can be considered within a MDT construct. Pulmonary metastasectomy literature characteristics Since 1980, greater than 1000 publications addressed pulmonary metastasectomy, without a single randomized controlled trial (RCT). The overwhelming majority is surgical series, usually single institution, and includes single or multiple pathologies. The pool of patients from which metastasectomy patients derive is not reported, allowing no comparative survival analysis. Historical controls are used or metastatic disease survival is assumed to be zero, a contention not supported by the literature. Yet metastasectomy is infrequently performed (1-6.5%) when sizable populations of cancer patients are reported. [1-3] Thus surgical case series manifest inherent selection bias and do not clarify the role of metastasectomy in prolongation of survival or cure. The literature is further hampered by inconsistent or absent description of other local or systemic therapies and variable length of follow up. Finally, the literature fails to distinguish between prognostic (indolent disease which will do well with any or no treatment) or predictive

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Reactivation of cytomegalovirus (CMV) from latency is a frequent complication of organ transplantation, and the molecular mechanism by which this occurs is unknown. Previous studies have shown that allogeneic stimulation induces reactivation of human CMV (HCMV) in vitro (64). We find that transplantation of vascularized allogeneic kidneys induces murine CMV (MCMV) and HCMV immediate-early (ie) gene expression. This induction is accompanied by increased expression of transcripts encoding inflammatory cytokines, including tumor necrosis factor (TNF), interleukin-2, and gamma interferon, and by activation of NF-B. TNF alone can substitute for allogeneic transplantation in inducing HCMV and MCMV ie gene expression in some tissues. Our studies suggest that reactivation is a multistep process which is initiated by factors that induce ie gene expression, including TNF and NF-B. Allogeneic transplantation combined with immunosuppression may be required to achieve complete reactivation in vivo.

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