Abstract

TOJAL, André  and  PINTO-DE-SOUSA, João. Multimodality Therapy for gastroesophageal junction carcinoma. Arq Med [online]. 2014, vol.28, n.3, pp.78-87. ISSN 2183-2447.

In Western countries there has been an alarming rise in the incidence of gastroesophageal junction adenocarcinoma. Based on epidemiological and histopathological data, these tumors are classified as adenocarcinoma of the distal esophagus, junctional adenocarcinoma, or true carcinoma of the cardia, and subcardial adenocarcinoma. Commonly, his clinical presentation occurs in advanced stages, thus, an early and adjusted therapeutic intervention is only possible through an early diagnosis, a standardized classification and an accurate staging. The strategy with curative intent is most often multidisciplinary, but surgical resection remains the treatment of choice, despite the percentage of R0 resection being far from ideal. Recent evidence suggests that a perioperative regimen with chemotherapy, with or without radiotherapy, can reduce locoregional recurrence, improving survival of patients with resectable gastroesophageal junction carcinoma. However, in unresectable adenocarcinomas or with distant metastases, systemic chemotherapy may be the only acceptable treatment option. New chemotherapeutic agents are under investigation in order to increase the efficacy and to reduce the toxicity of these combinations. This review paper aims to help clarify some of the controversies in the classification, staging and treatment of these carcinomas, with special emphasis on the different therapeutic options.

Keywords : gastroesophageal junction; adenocarcinoma; cardia; surgery; chemotherapy; multimodal therapy.

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