Multimodal therapy of GEJ cancer: When is the definitive radiochemotherapy the treatment of choice?

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. © 2012 Springer-Verlag Berlin Heidelberg.