Radiation therapy and upper gastrointestinal tract: esophageal, gastric, and pancreatic cancer. Toward new standards?
OBJECTIVE
To emphasize the role and place of chemoradiation in the treatment of patients with upper gastrointestinal tract cancer.


RESULTS
For esophagus cancer, in resectable stages IIA to IIB, squamous cell types, surgery remains standard treatment, and preoperative chemoradiation is investigational. After the results of two randomized trials conducted in France and Germany, however, chemoradiation alone is challenging surgery. In adenocarcinomas, preoperative chemoradiation is under investigation. In both types, new studies incorporating targeted therapies to chemoradiation are starting. For gastric cancer, chemoradiation after operation is standard of care in the United States but is still discussed in Europe. Preoperative chemoradiation is in current development, and future trials will compare preoperative strategies and strategies after operation. For pancreatic cancer, after a curative resection, chemoradiation in the United States and chemotherapy in Europe are standard of care, respectively. An ongoing European trial is comparing these two strategies after operation.


CONCLUSIONS
Recommendations are issued from the analysis of recently published clinical trials. New areas of development are discussed.
Bosset
J F
JF
Department of Radiation - Oncology, Besançon University Hospital, Besançon, France. jean-francois.bosset@ufc-chu.univ-fcomte.fr
Lorchel
F
F
D004938:Esophageal Neoplasms / Q000532:radiotherapy; D005770:Gastrointestinal Neoplasms / Q000532:radiotherapy*; D006801:Humans; D010190:Pancreatic Neoplasms / Q000532:radiotherapy; D018714:Radiotherapy, Adjuvant; D013274:Stomach Neoplasms / Q000532:radiotherapy; D041742:Upper Gastrointestinal Tract / Q000528:radiation effects*