title: Locally advanced gastroesophageal junction tumor: a treatment dilemma.
abstract: Over the last several decades, the incidence of adenocarcinoma of the gastroesophageal junction (GEJ) has been increasing in developed countries. Although complete surgical resection remains the cornerstone of treatment for resectable disease, long-term outcomes are poor and recurrence rates are high with surgery alone in patients presenting with locally advanced disease. Multimodal therapy has been shown to improve survival; however, the optimal therapeutic approach remains controversial, and practices vary across the world. Preoperative chemoradiotherapy is generally used in the U.S., whereas perioperative chemotherapy without radiation is favored in most European countries. In this review, we discuss why the treatment of locally advanced GEJ tumors remains controversial, examine the evidence for various multimodal approaches, discuss their respective pros and cons, evaluate the role of radiation therapy, highlight some ongoing and planned clinical trials, and suggest areas that need further research.
authors.affiliation: Department of Hematology/Oncology, University of South Florida/James A. Haley Veterans' Hospital, Tampa, Florida, USA; Department of Radiation Oncology, H. Lee Moffitt Cancer Center, Tampa, Florida, USA.
authors.forename: Noman
authors.initials: N
authors.lastname: Ashraf
authors.affiliation: Department of Hematology/Oncology, University of South Florida/James A. Haley Veterans' Hospital, Tampa, Florida, USA; Department of Radiation Oncology, H. Lee Moffitt Cancer Center, Tampa, Florida, USA.
authors.forename: Sarah
authors.initials: S
authors.lastname: Hoffe
authors.affiliation: Department of Hematology/Oncology, University of South Florida/James A. Haley Veterans' Hospital, Tampa, Florida, USA; Department of Radiation Oncology, H. Lee Moffitt Cancer Center, Tampa, Florida, USA richard.kim@moffitt.org.
authors.forename: Richard
authors.initials: R
authors.lastname: Kim
mesh_terms: D000230:Adenocarcinoma / Q000188:drug therapy* / Q000473:pathology / Q000532:radiotherapy; D059248:Chemoradiotherapy; D003131:Combined Modality Therapy; D004938:Esophageal Neoplasms / Q000188:drug therapy* / Q000473:pathology / Q000532:radiotherapy; D004943:Esophagogastric Junction / Q000187:drug effects / Q000473:pathology / Q000528:radiation effects; D006801:Humans; D009364:Neoplasm Recurrence, Local / Q000188:drug therapy* / Q000473:pathology / Q000532:radiotherapy
keywords: Adenocarcinoma; Chemotherapy; Gastroesophageal cancer; Radiation