Published online Jul 24, 2021. doi: 10.5306/wjco.v12.i7.557
Peer-review started: February 25, 2021
First decision: May 4, 2021
Revised: May 10, 2021
Accepted: June 25, 2021
Article in press: June 25, 2021
Published online: July 24, 2021
Multimodal treatment is currently the standard of care for locally advanced esophagogastric junction (EGJ) adenocarcinoma due to poor results after surgery alone. Neoadjuvant therapy is intended to shrink the tumor and eliminate potential circulating tumor cells. However, which neoadjuvant treatment is best for patients with EGJ tumors remains controversial. We aimed to compare outcomes of preoperative chemoradiation and perioperative chemotherapy for EGJ adenocarcinomas. For this purpose, we performed a thorough review of the literature describing neoadjuvant treatments for EGJ adenocarcinomas or comparing both therapies. Although some studies have shown better locoregional control and higher rates of complete pathologic response after chemoradiation, data suggest that both types of neoadjuvant therapy have similar survival benefits. As current data are heterogeneous and many studies have included significantly different types of patients in their analysis, future studies with better patient selection are still needed to define which neoadjuvant therapy should be chosen. In addition, targeted therapies and immunotherapy have promising results and should be further explored.
Core Tip: Surgical treatment only has shown poor results in patients with locally advanced esophagogastric junction tumors. Perioperative chemotherapy and neoadjuvant chemoradiation are valid treatment modalities for these patients. This evidence-based review explores the results, advantages, and disadvantages of both approaches. In addition, future directions with potentially effective novel drugs are also discussed.