Management of Locally Advanced Adenocarcinoma of the Esophagus and Gastroesophageal Junction: Finally a Consensus

Kleinberg, Lawrence; Brock, Malcolm V.; Gibson, Michael K.

doi:10.1007/s11864-015-0352-6

Cited by 15 publications

(16 citation statements)

References 75 publications

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“…This is consistent with the POET trial showing that the length of hospital stay was longer in NACRT compared to NAC and is also associated with increased inpatient mortality [7]. Other studies also show increased complications and postoperative death with the addition of radiotherapy [27,28].…”

Section: Discussionsupporting

confidence: 86%

No Difference in Survival between Neo-Adjuvant Chemotherapy and Neo-Adjuvant Chemoradiation Therapy in Gastric Cardia Cancer Patients: A Contemporary View from the National Cancer Database

et al. 2019

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Introduction: Both neo-adjuvant chemoradiation therapy (NACRT) and neo-adjuvant chemotherapy (NAC), in addition to surgical resection of gastric cardia cancer, improves survival outcomes. We assessed whether NACRT or NAC had superior overall survival (OS) and relative survival (RS) outcomes using the National Cancer Database (NCDB). Methods: The NCDB from 2006 to 2014 was reviewed to identify non-metastatic adult gastric cardia cancer patients who underwent surgical resection and received NACRT or NAC. Advanced statistical models were applied to assess survival outcomes. Results: Of the 5,371 patients included, 4,520 (84.2%) were male, the mean age was 61.2 years (SD 10.0), 4,229 (78.7%) underwent NACRT, and 1,142 (21.3%) underwent NAC. NACRT patients more often had an R0 resection compared to NAC (91.4 vs. 86.6%, p < 0.001, respectively). Univariate 5-year OS rates were 40.0% (95% CI 38.2-41.8) for NACRT and 40.1% (37.0-43.6) for NAC (p = 0.302). No differences in OS for NAC vs. NACRT were found after multivariable analysis (hazard ratio [HR] 0.95, 95% CI 0.86-1.05, p = 0.290). There were no survival differences after stepwise, propensity score, RS analyses, nor after near-far-matching (HR 0.94, 95% CI 0.82-1.07, p = 0.332). Conclusions: NAC or NACRT yield the same survival outcome for patients with resectable gastric cardia cancer. These data support the need for randomized controlled trials comparing the 2 regimens head-to-head.

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Section: Discussionsupporting

confidence: 86%

No Difference in Survival between Neo-Adjuvant Chemotherapy and Neo-Adjuvant Chemoradiation Therapy in Gastric Cardia Cancer Patients: A Contemporary View from the National Cancer Database

et al. 2019

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“…18,19 The addition of neoadjuvant chemotherapy or chemoradiotherapy, centralization of surgical treatment, improvements in perioperative care, as well as more accurate patient selection following developments in imaging techniques and involvement of a multi-disciplinary team, have all had positive effects on the EGJ cancer prognosis following surgery. 20,21 Yet, the optimal M A N U S C R I P T A C C E P T E D ACCEPTED MANUSCRIPT 3 surgical strategy for these tumors remains controversial. The lack of consensus regarding the definition of EGJ cancer and the difficulties in assessing the exact origin of these tumors contribute to this controversy.…”

Section: Introductionmentioning

confidence: 99%

The surgical management of esophago-gastric junctional cancer

Kauppila

Lagergren

2016

Surgical Oncology

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The best available surgical strategy in the treatment of resectable esophago-gastric junctional (EGJ) cancer is a controversial topic. In this review we evaluate the current literature and scientific evidence examining the surgical treatment of locally advanced EGJ cancer by comparing esophagectomy with gastrectomy, transhiatal with transthoracic esophagectomy, minimally invasive with open esophagectomy, and less extensive with more extensive lymphadenectomy. We also assess endoscopic procedures increasingly used for early EGJ cancer. The current evidence does not favor any of the techniques over the others in terms of oncological outcomes. Health-related quality of life may be better following gastrectomy compared to esophagectomy. Minimally invasive procedures might be less prone to surgical complications. Endoscopic techniques are safe and effective alternatives for early-stage EGJ cancer in the short term, but surgical treatment is the mainstay in fit patients due to the risk of lymph node metastasis. Any benefit of lymphadenectomy extending beyond local or regional nodes is uncertain. This review demonstrates the great need for well-designed clinical studies to improve the knowledge in how to optimize and standardize the surgical treatment of EGJ cancer.

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“…esophagogastric junction comprised 20-25% of the cohort, with only 15% having clinical T2 status. 3,4 Reflective of the limitations of clinical staging for esophagogastric cancer, [5][6][7] the pathologic staging can often differ with the initial preoperative staging. As a consequence of staging limitations, the OS benefit of NAC or perioperative chemotherapy is very difficult to discern prior to surgery.…”

mentioning

confidence: 99%

Does neoadjuvant/perioperative chemotherapy improve overall survival for T2N0 gastric adenocarcinoma?

Gabriel

Attwood

Narayanan

et al. 2017

Journal of Surgical Oncology

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Management of Locally Advanced Adenocarcinoma of the Esophagus and Gastroesophageal Junction: Finally a Consensus

Cited by 15 publications

References 75 publications

No Difference in Survival between Neo-Adjuvant Chemotherapy and Neo-Adjuvant Chemoradiation Therapy in Gastric Cardia Cancer Patients: A Contemporary View from the National Cancer Database

No Difference in Survival between Neo-Adjuvant Chemotherapy and Neo-Adjuvant Chemoradiation Therapy in Gastric Cardia Cancer Patients: A Contemporary View from the National Cancer Database

The surgical management of esophago-gastric junctional cancer

Does neoadjuvant/perioperative chemotherapy improve overall survival for T2N0 gastric adenocarcinoma?

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