Diagnosis and therapy in advanced cancer of the esophagus and the gastroesophageal junction.
OBJECTIVE
The aim of this article is to discuss recent developments in the diagnosis and treatment with curative option of advanced cancer of the esophagus and gastroesophageal junction.


RESULTS
Recent data indicate improvement of clinical staging accuracy by multi-slice computer tomography, endoscopic ultrasound with fine needle aspiration and positron emission tomography, the latter gaining growing impact as a prognostic indicator. When combined with extended lymphadenectomy primary surgery offers 5-year survivals between 25 and 35% for stage III disease. Results of induction therapy remain conflicting. While the most recent meta-analysis favored induction chemoradiotherapy, a subsequent randomized trial failed to confirm this conclusion. A growing interest in adjuvant chemoradiotherapy is stimulated by promising results from a recent pilot study. Trials investigating definitive chemoradiotherapy indicate a high incidence of locoregional recurrence. The emerging understanding of the molecular pathways that govern neoplastic events are under intense investigation. Results of pilot clinical studies on targeted therapy are expected shortly.


CONCLUSIONS
Refinements in staging offer incremental increase of accuracy, the impact of positron emission tomography becoming increasingly important. In locally advanced disease, the debate on the added value of multimodality therapy remains unsolved as primary surgery combined with extended lymphadenectomy offers equal results. New drugs in particular in combination with targeted therapy may offer better perspectives in the near future.
Lerut
Toni
T
Department of Thoracic Surgery, University Hospitals Leuven, Leuven, Belgium. Toni.Lerut@uz.kuleuven.ac.be
Coosemans
Willy
W
Decker
Georges
G
De Leyn
Paul
P
Moons
Johnny
J
Nafteux
Philippe
P
Van Raemdonck
Dirk
D
D001707:Biopsy, Needle; D003131:Combined Modality Therapy / Q000379:methods; D003937:Diagnosis, Differential; D019160:Endosonography; D004938:Esophageal Neoplasms / Q000175:diagnosis* / Q000628:therapy*; D004943:Esophagogastric Junction; D006801:Humans; D009367:Neoplasm Staging; D049268:Positron-Emission Tomography; D011379:Prognosis; D013274:Stomach Neoplasms / Q000175:diagnosis* / Q000628:therapy*; D014057:Tomography, X-Ray Computed