PMID- 20117883
OWN - NLM
STAT- MEDLINE
DCOM- 20100921
LR  - 20100726
IS  - 1532-1967 (Electronic)
IS  - 0305-7372 (Linking)
VI  - 36
IP  - 5
DP  - 2010 Aug
TI  - Localized adenocarcinoma of the esophagogastric junction--is there a standard of 
      care?
PG  - 400-9
LID - 10.1016/j.ctrv.2010.01.001 [doi]
AB  - Adenocarcinoma of the esophagogastric junction (AEG) is the most rapidly 
      increasing tumour in the Western world. Most patients present with locally 
      advanced resectable disease and treatment can be curative. However, no accepted 
      standard treatment exists. Cancer specialists frequently differ on optimum 
      treatment strategies. Areas of debate include the aetiology of AEG, TNM staging, 
      type and extent of resection, relative benefits of preoperative chemotherapy 
      versus preoperative chemoradiation (CRT) versus post-operative CRT, use of early 
      PET scan, and integration of targeted therapy. Randomized trials are weakened by 
      underpowered numbers for AEG tumours, and by methodologic flaws. R0 resection and 
      pathologic complete responses (pCR) predict long-term survival, and most 
      treatment strategies target this as a proxy measure of improved outcome. Some 
      preoperative chemotherapy trials show a benefit but the numbers of true AEG 
      tumours in these studies is unclear. The MAGIC study was powered for gastric 
      cancer only, with just 27% of patients having AEG. Compared with chemotherapy 
      alone, preoperative CRT trials show higher rates of pCR. A large randomized 
      study, with significant toxicity, has shown long-term benefit with adjuvant CRT 
      after resection of gastric cancer (20% AEG). An international consensus on the 
      true definition and optimum management of AEG is required. Molecular and imaging 
      biomarkers will play a vital role in future trials. Trimodality therapy is likely 
      to be optimum with surgery shifted to later in the treatment pathway. Rectal 
      cancer provides an analogous paradigm in this regard. As systemic disease is the 
      primary cause of mortality chemosensitivity should be determined early.
CI  - Copyright 2010 Elsevier Ltd. All rights reserved.
FAU - Power, D G
AU  - Power DG
AD  - Department of Medical Oncology, St. James's Hospital, Dublin, Ireland.
FAU - Reynolds, J V
AU  - Reynolds JV
LA  - eng
PT  - Journal Article
PT  - Review
DEP - 20100201
PL  - Netherlands
TA  - Cancer Treat Rev
JT  - Cancer treatment reviews
JID - 7502030
SB  - IM
MH  - Adenocarcinoma/pathology/*therapy
MH  - Combined Modality Therapy/methods
MH  - Esophageal Neoplasms/pathology/*therapy
MH  - *Esophagogastric Junction
MH  - Humans
MH  - Neoplasm Staging
MH  - Stomach Neoplasms/pathology/*therapy
MH  - Treatment Outcome
RF  - 119
EDAT- 2010/02/02 06:00
MHDA- 2010/09/23 06:00
CRDT- 2010/02/02 06:00
PHST- 2009/11/23 00:00 [received]
PHST- 2010/01/06 00:00 [revised]
PHST- 2010/01/08 00:00 [accepted]
PHST- 2010/02/02 06:00 [entrez]
PHST- 2010/02/02 06:00 [pubmed]
PHST- 2010/09/23 06:00 [medline]
AID - S0305-7372(10)00004-6 [pii]
AID - 10.1016/j.ctrv.2010.01.001 [doi]
PST - ppublish
SO  - Cancer Treat Rev. 2010 Aug;36(5):400-9. doi: 10.1016/j.ctrv.2010.01.001. Epub 
      2010 Feb 1.