Combined Therapy of Locally Advanced Oesophageal and Gastro-Oesophageal Junction Adenocarcinomas: State of the Art and Aspects of Predictive Factors.

Milan Vošmik,Stanislav John,Jindřich Kopecký,Igor Sirák,Libor Hruška,Aml Mustafa Banni,Petr Lochman,Ondřej Kubeček

doi:10.3390/cancers13184591

Abstract

Simple SummaryThe optimal treatment strategy for locally advanced distal oesophageal and gastrooesophageal junction (GOJ) adenocarcinoma is currently not clear. Surgery as a main curative modality is usually combined with either preoperative chemoradiotherapy or perioperative chemotherapy. The aim of the review is to provide an overview of current treatment options in locally advanced oesophageal and GOJ adenocarcinomas based on the latest evidence, including the possible potential of predictive biomarkers in optimizing treatment.The following main treatment approaches are currently used in locally advanced adenocarcinomas of the oesophagus and gastrooesophageal junction (GOJ): preoperative chemoradiotherapy and surgery, and perioperative chemotherapy and surgery. While preoperative chemoradiotherapy is used primarily in oesophageal tumours, perioperative chemotherapy is the treatment of choice in Western countries for gastric cancer. The optimal treatment strategy for GOJ adenocarcinoma is still not clear. In comparison to other malignancies, biomarkers are used as predictive factors in distal oesophageal and GOJ adenocarcinomas in a very limited way, and moreover, only in metastatic stages (e.g., HER2 status, or microsatellite instability status). The aim of the article is to provide an overview of current treatment options in locally advanced adenocarcinomas of oesophagus and GOJ based on the latest evidence, including the possible potential of predictive biomarkers in optimizing treatment.

Highlights

The epidemiology of gastroesophageal tumours has been changing over the last decades in Europe and North America
Preoperative chemoradiotherapy and surgery is commonly used in locally advanced resectable oesophageal tumour, whereas surgery combined with perioperative chemotherapy, or surgery followed by postoperative chemoradiotherapy, has been adopted as the standard of care (SOC) in gastric cancer in Western countries
We can treat oesophageal and gastro-oesophageal junction (GOJ) adenocarcinomas according to guidelines for oesophageal tumours using preoperative chemoradiotherapy, and as primary tumour of the stomach with perioperative chemotherapy

Summary

Introduction

While the incidence of oesophageal squamous cell carcinoma decreases, the number of patients with adenocarcinoma of oesophagus and gastro-oesophageal junction (GOJ) is on the rise making it the dominant histological cancer type [2,3]. Preoperative chemoradiotherapy and surgery is commonly used in locally advanced resectable oesophageal tumour, whereas surgery combined with perioperative chemotherapy, or surgery followed by postoperative chemoradiotherapy, has been adopted as the SOC in gastric cancer in Western countries. With regards to locally advanced adenocarcinomas of the distal oesophagus and GOJ, the optimal treatment strategy is much less clear. These tumours were included in large randomized clinical trials that have defined standard practice in oesophageal carcinomas as well as in “practice changing” clinical trials in gastric cancer. The results of some randomized clinical trials with innovative drugs, including immune-check-point inhibitors, that have already changed treatment standards and further clinical research, have recently been published

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