Neoadjuvant therapy for gastroesophageal adenocarcinoma

Abstract

Gastric and esophageal adenocarcinomas are one of the main causes of cancer-related death worldwide. While the incidence of gastric adenocarcinoma is decreasing, the incidence of gastroesophageal junction adenocarcinoma is rising rapidly in Western countries. Considering that surgical resection is currently the major curative treatment, and that the 5-year survival rate highly depends on the pTNM stage at diagnosis, gastroesophageal adenocarcinoma management is very challenging for oncologists. Several treatment strategies are being evaluated, and among them systemic chemotherapy, to decrease recurrences and improve overall survival. The MAGIC and FNCLCC-FFCD trials showed a survival benefit of perioperative chemotherapy in patients with operable gastric and lower esophageal cancer, and these results had an impact on the European clinical practice. New strategies, including induction chemotherapy followed by preoperative chemoradiotherapy, targeted therapies in combination with perioperative chemotherapy and the new cytotoxic regimens, are currently assessed to improve current standards and help developing patienttailored therapeutic interventions. Core tip: Gastric and esophageal adenocarcinomas are one of the main causes of cancer-related death worldwide. The incidence of gastroesophageal junction adenocarcinoma is rapidly rising in Western countries. Surgical resection is currently the major curative treatment. As the 5-year survival rate highly depends on the pTNM stage, the treatment strategy is very challenging for oncologists. Several treatments, including systemic chemotherapy, are being assessed to prevent recurrences and improve overall survival. New strategies, such as induction chemotherapy followed by preoperative chemoradiotherapy, targeted therapies and new cytotoxic regimens in perioperative chemotherapy, are currently assessed to improve current standards and develop more tailored therapeutic interventions.

Safety and feasibility of preoperative exercise training during neoadjuvant treatment before surgery for adenocarcinoma of the gastro-oesophageal junction

“…For many patients, surgical removal of the primary tumour is an essential component of treatment with intent to cure . Neoadjuvant chemotherapy or chemoradiotherapy is used widely in patients with locally advanced or node‐positive tumours to achieve clear resection margins and improve long‐term survival . Although neoadjuvant treatments have improved long‐term survival, these approaches are not without challenges.…”

Current trends in gastric cancer treatment in Europe

“…For locally advanced gastric cancer, radical gastrectomy with D2 lymph node dissection has become the standard surgery in most European high volume centers [5] . In addi-tion, perioperative chemotherapy (CT) is the standard therapy in curatively intended disease in most European countries [6][7][8][9][10] , and also molecular targeted therapy has been implemented in human epidermal growth factor receptor (HER)-2 positive tumors in the palliative setting [11] . This review gives an overview of current surgical and perioperative management in curatively intended treatment for localized gastric cancer, as well as palliative management for metastatic disease, in Europe.…”

High Age Increases the Risk of Complications and Reduces Survival Following Esophagectomy for Adenocarcinoma

“…The incidence of esophageal cancer and gastroesophageal junction (GEJ) cancer is rising, rendering it the sixth most common cause of cancer-related death worldwide [1]. Despite the recent introduction of multimodal regimes, surgery is still the preferred curative treatment option for esophageal and GEJ cancer [2]. However, resection of esophageal and GEJ cancer is a major procedure and it is therefore mandatory to ensure that potential patients present with an acceptable performance status without severe comorbidities.…”