Trimodality treatment in gastric and gastroesophageal junction cancers: Current approach and future perspectives

Abstract

Gastric and gastroesophageal junction (GEJ) cancers represent an aggressive group of malignancies with poor prognosis even when diagnosed in relatively early stage, with an increasing incidence both in Asia and in Western countries. These cancers are characterized by heterogeneity as a result of different pathogenetic mechanisms as shown in recent molecular analyses. Accordingly, the understanding of phenotypic and genotypic correlations/classifications has been improved. Current therapeutic strategies have also advanced and moved beyond surgical extirpation alone, with the incorporation of other treatment modalities, such as radiation and chemotherapy (including biologics). Chemoradiotherapy has been used as postoperative treatment after suboptimal gastrectomy to ensure local disease control but also improvement in survival. Preoperative chemoradiotherapy/chemotherapy has been employed to increase the chance of a successful R0 resection and pathologic complete response rate, which is associated with improved long-term outcomes. Several studies have defined various chemotherapy regimens to accompany radiation (before and after surgery). Recently, addition of immunotherapy after trimodality of gastroesophageal cancer has produced an advantage in disease-free interval. Targeted agents used in the metastatic setting are being investigated in the early setting with mixed results. The aim of this review is to summarize the existing data on trimodality approaches for gastric and GEJ cancers, highlight the remaining questions and present the current research effort addressing them.

División ganglionar posquirúrgica y su efecto en el recuento ganglionar y la estadificación en pacientes con cáncer gástrico

“…La gastrectomía con una adecuada linfadenectomía es el pilar del tratamiento y está relacionada con un mejor pronóstico, siendo un indicador de recurrencia y supervivencia. Las guías recomiendan más de 15 ganglios para una estadificación adecuada 4,5 .…”

CD44 is a prognostic biomarker and correlated with immune infiltrates in gastric cancer

“…It is still a major disease affecting human life and health. Currently, the treatment of gastric carcinoma is based on surgery and neoadjuvant therapy, postoperative chemotherapy and biological immunotherapy[ 2 ]. However, patients with early gastric cancer generally do not have obvious symptoms, so it is not easy to detect, and most patients diagnosed for the first time already have advanced gastric cancer [ 3 ].…”

Radiation-Induced Esophageal Cancer: Investigating the Pathogenesis, Management, and Prognosis

“…Incorporation of combined modality treatment (including neoadjuvant chemotherapy, radiotherapy, and surgical resection) has been employed for the management of locally advanced esophageal and gastroesophageal junction cancers [ 1 ]. The trimodal approach can potentially achieve higher rates of (a) tumor shrinkage-downstaging, (b) negative tumor resection (R0) margins, and (c) pathological complete response (pCR), thus offering lower disease recurrence rate and overall survival improvement [ 2 , 3 , 4 , 5 , 6 , 7 ]. The combination of (a) imaging with targeted irradiation techniques (i.e., Intensity-modulated radiation therapy, volumetric modulated arc therapy, protons), (b) 4D-Computed Tomography (CT) planning or other respiratory motion management methods, and (c) biological targeting (i.e., Positron Emission Tomography (PET)/CT implementation in radiotherapy planning) can offer more accurate planning to target volume delineation margins that minimize healthy surrounding tissue dose (i.e., heart substructures and lungs) and limit early and late toxicity incidences [ 1 , 8 , 9 , 10 , 11 , 12 ].…”