Cancer of the gastroesophageal junction: Current therapy options

Active chemotherapy agents in metastatic adenocarcinoma of the esophagus include taxanes (docetaxel or paclitaxel), 5-fluorouracil, irinotecan, platinum drugs (including cisplatin, oxaliplatin, and carboplatin), and anthracyclines. Conventional chemotherapy combines infusional 5-fluorouracil with cisplatin. The addition of a third drug to this backbone results in greater toxicity and only marginal improvements in outcome. Alternative and potentially better-tolerated chemotherapy involves two-drug regimens, combining 5-fluorouracil with a taxane or irinotecan, or combining a platinum drug with irinotecan or a taxane. Although preoperative chemotherapy improves survival compared with surgery alone, the addition of radiation therapy to chemotherapy preoperatively improves rates of curative resection, reduces local tumor recurrence, and achieves a significant rate of pathologic complete response. Combined preoperative chemotherapy and concurrent radiotherapy is the preferred preoperative strategy for locally advanced adenocarcinoma of the esophagus. Survival is improved with postoperative chemotherapy and radiotherapy if none has been delivered preoperatively.