Preoperative chemoradiotherapy or perioperative chemotherapy for patients with gastro-oesophageal junction adenocarcinoma

[...]for adenocarcinoma of the oesophagus or gastro-oesophageal junction, there is ongoing debate about the use of chemotherapy alone or combined chemoradiotherapy followed by surgery as the most effective pre-surgery treatment. Because of the confines of the mediastinum and absence of a peritoneal...

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Bibliographic Details
Published in:The lancet oncology 2023-06, Vol.24 (6), p.593-595
Main Authors: Ilson, David H, Al-Batran, Salah-Eddin
Format: Article
Language:English
Subjects:
Adenocarcinoma
Cancer therapies
Cardiovascular diseases
Chemoradiotherapy
Chemotherapy
Clinical trials
Esophagus
Immunotherapy
Malignancy
Mediastinum
Patients
Radiation therapy
Surgery
Tumors
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Summary:[...]for adenocarcinoma of the oesophagus or gastro-oesophageal junction, there is ongoing debate about the use of chemotherapy alone or combined chemoradiotherapy followed by surgery as the most effective pre-surgery treatment. Because of the confines of the mediastinum and absence of a peritoneal lining in oesophageal and Siewert type 1 and 2 gastro-oesophageal junction adenocarcinomas, the issues of R0 resection, response to treatment, achievement of a node negative status, and local recurrence become important. Additionally, only 24% of the patients in the CROSS trial had gastro-oesophageal junction cancer, and the outcomes for this important group were not reported. [...]from an objective perspective, any clinical decision to administer chemoradiotherapy rather than chemotherapy to a patient with localised adenocarcinoma of the gastro-oesophageal junction is a risky decision. In addition to the surgical mortality that was increased in some trials after chemoradiotherapy (eg, 10% in the POET trial, assessing the addition of radiotherapy to neoadjuvant chemotherapy for patients with adenocarcinoma or the oesophagus), radiotherapy causes long-term complications such as cardiovascular disease and secondary malignancies. [...]a compelling justification for opting for a chemoradiotherapy approach over chemotherapy alone is needed. The individual studies contributed a weight of more than 5% of the total population of the meta-analysis were uniformly negative. [...]except for one study, individual studies that contributed a relative weight of more than 7% showed a detrimental effect on survival (HR >1) when radiotherapy was added to chemotherapy.
ISSN:1470-2045
1474-5488
DOI:10.1016/S1470-2045(23)00244-9