Cancer of the esophagus and gastro-esophageal junction: potentially curative therapies.
The definition of potential curative tumors of the esophagus and gastro-esophageal junction remains problematic. This is due to a lack of accuracy in clinical staging despite recent advances in CT, endoscopic ultrasonography (EUS), positron emission tomography scan and minimally invasive staging modalities. As a result much controversy persists regarding indications for surgery and extent of resection and lymphadenectomy. Today surgery with curative option results in five-year survival of over 30%. Multimodality regimens, especially neoadjuvant chemoradiotherapy, seem to be beneficial in patients with a complete response on pathologic staging. Other indications are investigational and should be studied within carefully monitored study protocols. In early carcinoma T(is)-T(1a) endoluminal ablation technique seem to open promising perspectives provided of discrimination between T(is)-T(1a) and T(1b) can be made by the use of 20mhz EUS probes.
Lerut
T
T
Department Thoracic Surgery, Catholic University Leuven, U.Z. Gasthuisberg, Herestraat 49, 3000, Leuven, Belgium. toni.lerut@uz.kuleuven.ac.be
Coosemans
W
W
Decker
G
G
De Leyn
P
P
Nafteux
P
P
Van Raemdonck
D
D
D000230:Adenocarcinoma / Q000473:pathology / Q000601:surgery* / Q000628:therapy; D004938:Esophageal Neoplasms / Q000473:pathology / Q000601:surgery* / Q000628:therapy; D016629:Esophagectomy / Q000379:methods; D004943:Esophagogastric Junction; D006801:Humans; D020360:Neoadjuvant Therapy / Q000379:methods; D009367:Neoplasm Staging; D015996:Survival Rate