Adjuvant or neoadjuvant therapy for operable esophagogastric cancer?

Abstract

Esophagogastric cancer encompasses proximal squamous cell carcinoma of the esophagus, distal esophageal/junctional adenocarcinoma of the esophagus and gastric adenocarcinoma. These diseases have different etiologies, geographic incidences and biologies. This review mainly focuses on the treatment of operable esophagogastric adenocarcinoma. In Asia, adjuvant chemotherapy is commonly used for patients with gastric cancer following the landmark ACTS-GC trial. In contrast, perioperative chemotherapy is a standard of care in many Western countries based on the results of the MAGIC trial.

Neoadjuvant vs. adjuvant treatment of Siewert type II gastroesophageal junction cancer: an analysis of data from the surveillance, epidemiology, and end results (SEER) registry

“…Although the study does not mention the Siewert classification, it is likely that they excluded Siewert I since these are distal esophageal cancers. The study showed survival benefit for patients receiving adjuvant CRT compared with surgery alone (12,16).…”

“…The study showed increased OS in patients treated with neoadjuvant CRT compared to surgery alone, but this was strongly driven by the 23% of patients with squamous cell carcinoma. When isolating the population of patients with adenocarcinoma, the benefits only approached significance (P=0.07) (11,16).…”

“…Patients with multiple primary malignancies (5,558), metastatic disease (3,759), unknown stage group (1,727), stage group IA (2,012), unknown grade (5,568), no cancer-directed surgery (9,910), no radiation therapy (RT) (16,505), or cases where it was unknown if RT was administered (1,012) were excluded from the study. Stage group IA was removed since this group was not included in the Intergroup 0116 trial, and these patients were more likely to receive surgery alone.…”

Neoadjuvant Radiochemotherapy for Patients with Locally Advanced Esophagogastric Junction Adenocarcinoma

“…Also, neoadjuvant treatment can induce tumor downstaging, raising the possibility of complete surgical resection. This may be particularly important in western populations because these patients often have more advanced tumors than Asian patients (10).…”

“…There are authors who consider that patients with esophagogastric junction adenocarcinomas are more susceptible to develop distant disease and therefore a systemic approach to chemotherapy can be more beneficial than an localized only treatment strategy for these patients (23).…”