Over the last several decades, the incidence of adenocarcinoma of the gastroesophageal junction (GEJ) has been increasing in developed countries. Although complete surgical resection remains the cornerstone of treatment for resectable disease, long-term outcomes are poor and recurrence rates are high with surgery alone in patients presenting with locally advanced disease. Multimodal therapy has been shown to improve survival; however, the optimal therapeutic approach remains controversial, and practices vary across the world. Preoperative chemoradiotherapy is generally used in the U.S., whereas perioperative chemotherapy without radiation is favored in most European countries. In this review, we discuss why the treatment of locally advanced GEJ tumors remains controversial, examine the evidence for various multimodal approaches, discuss their respective pros and cons, evaluate the role of radiation therapy, highlight some ongoing and planned clinical trials, and suggest areas that need further research.
摘要
在过去的几十年中，发达国家的胃食管交界处（GEJ）腺癌发病率不断升高。虽然完全切除手术仍是可切除性疾病的治疗基础，但长期预后不佳，且局部晚期疾病患者接受单纯手术治疗后的复发率较高。研究显示，多元模式治疗可以改善患者的生存情况；但最佳治疗方法仍存在争议，在全世界各地的临床实践中采用的方法各不相同。在美国普遍使用术前同步放化疗，而在大多数欧洲国家更倾向于使用围手术期化疗而不使用放疗。本综述将讨论局部晚期GEJ肿瘤治疗仍存在争议的原因，审阅各种多元模式治疗的证据，讨论各种方法的优点和缺点，评估放疗的作用，重点介绍部分正在进行和计划进行的临床试验，并提出需要进一步研究的领域。The Oncologist 2015;20:134–142
Keywords: Adenocarcinoma; Chemotherapy; Gastroesophageal cancer; Radiation.
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