title: What's the Best Way to Treat GE Junction Tumors? Approach Like Gastric Cancer.
abstract: The debate as to the optimal classification, staging, and treatment of gastroesophageal junction (GEJ) tumors wages on, and one must acknowledge that there is no "one-size-fits-all" approach. However, in this review we are charged with defending the position that all GEJ tumors are best treated like gastric cancer. We submit that, as stated, this is not a defensible position and that a clear definition of terms is warranted. Given the rarity of squamous cell carcinoma and the dramatic rise in incidence of adenocarcinoma of the GEJ in the West, we define GEJ "tumors" to mean adenocarcinomas of the GEJ. Furthermore, on the basis of their location, pathogenesis, and biologic behavior, we submit that few would argue with the contention that Siewert type I GEJ tumors are best treated like distal esophageal cancer and that Siewert type III GEJ tumors are best treated like gastric cancer. The real debate concerns the management of Siewert type II GEJ tumors, which arise immediately at the esophagogastric junction. Thus, for the purposes of this review, we have taken the liberty of redefining the question as what's the best way to treat adenocarcinomas of the true GEJ (i.e., Siewert type II tumors), and we submit that these tumors are in fact best treated like gastric cancer. This approach ensures that patients receive those therapies needed for the locoregional and systemic control of their disease together with a surgical procedure that optimizes complete tumor and regional lymph node resection while limiting morbidity.
authors.affiliation: Division of Surgical Oncology, Department of Surgery, Massachusetts General Hospital, Boston, MA, USA. jmullen@partners.org.|Harvard Medical School, Boston, MA, USA. jmullen@partners.org.
authors.forename: John T
authors.initials: JT
authors.lastname: Mullen
authors.affiliation: Harvard Medical School, Boston, MA, USA.|Department of Medical Oncology, Massachusetts General Hospital, Boston, MA, USA.
authors.forename: Eunice L
authors.initials: EL
authors.lastname: Kwak
authors.affiliation: Harvard Medical School, Boston, MA, USA.|Department of Radiation Oncology, Massachusetts General Hospital, Boston, MA, USA.
authors.forename: Theodore S
authors.initials: TS
authors.lastname: Hong
mesh_terms: D000230:Adenocarcinoma / Q000628:therapy*; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D059186:Chemoradiotherapy, Adjuvant; D017024:Chemotherapy, Adjuvant; D004938:Esophageal Neoplasms / Q000628:therapy*; D016629:Esophagectomy; D004943:Esophagogastric Junction / Q000601:surgery*; D005743:Gastrectomy; D006801:Humans; D020360:Neoadjuvant Therapy; D011184:Postoperative Period; D057234:Preoperative Period; D013274:Stomach Neoplasms / Q000628:therapy*