Published online Jun 15, 2014. doi: 10.4251/wjgo.v6.i6.145
Revised: April 2, 2014
Accepted: April 11, 2014
Published online: June 15, 2014
Oesophageal junctional adenocarcinoma is a challenging and increasingly common disease. Optimisation of pre-operative staging and consolidation of surgery in large volume centres have improved outcomes, however the preferred adjunctive treatment approach remains a matter of debate. This review examines the benefits of neoadjuvant, peri-operative, and post-operative chemotherapy and chemoradiotherapy in this setting in an attempt to reach an evidence based conclusion. Recent findings relating to the molecular characterisation of oesophagogastric cancer and their impact on therapeutics are explored, in addition to the potential benefits of fluoro-deoxyglucose positron emission tomography (FDG-PET) directed therapy. Finally, efforts to decrease the incidence of junctional adenocarcinoma using early intervention in Barrett’s oesophagus are discussed, including the roles of screening, endoscopic mucosal resection, ablative therapies and chemoprevention.
Core tip: Cancer of the gastro-oesophageal junction is an increasingly common phenomenon. For patients with operable junctional cancer, the only curative treatment option is surgery, however the optimal peri-operative treatment is controversial. We review the evidence supporting the use of chemotherapy and chemoradiotherapy in the pre- and postoperative settings for these patients, and go on to highlight how current research into the molecular mechanisms underpinning gastro-oesophageal cancer may lead to future effective treatment options.