ESMO E-Learning: Optimising the Assessment and Therapy of Oesophago-Gastric Junction Adenocarcinomas

Learning Objectives

  • To provide an update on assessment in patients with oesophago-gastric junction adenocarcinoma
  • To provide an update on therapeutic management of patients with oesophago-gastric junction adenocarcinoma
  • To summarise current diagnostic-therapeutic algorithm and put into perspective research directions in patients with oesophago-gastric junction adenocarcinoma
Title Duration Content CME Points CME Test
Optimising the Assessment and Therapy of Oesophago-Gastric Junction Adenocarcinomas 23 min. 31 slides 1 Take Test
David Cunningham
David Cunningham
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Elisa Fontana
Elisa Fontana
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Oesophago-gastric junction adenocarcinoma incidence is increasing. In the educational arena it is usually covered together with gastric cancer. There is little material available focusing on oesophago-gastric junction cancer, therefore one of the values of this E-learning module lies in a fully dedicated material thoroughly elaborated by carefully balanced expertise.

The authors cover epidemiology, definition, classification, staging and risk assessment, as well as practice recommendations for treatment, including curative treatment strategies.
In terms of loco-regional disease, the authors elaborate state of the science and currently ongoing studies for each of the following approaches: neoadjuvant chemotherapy, perioperative chemotherapy, neoadjuvant chemoradiation, neoadjuvant chemotherapy vs. chemoradiation, induction chemotherapy plus chemoradiotherapy vs. chemotherapy or chemoradiotherapy.

The evidence is in favour of both neoadjuvant chemotherapy and chemoradiation compared to surgery alone. Pre or peri-operative chemotherapy approaches are evidence-based approaches. The choice should be tailored on patients’ preference, co-morbidities and tolerance to treatments.

Definitive chemoradiation is primarily recommended for oesophageal Squamous cell carcinoma. A small number of patients with a diagnosis of adenocarcinoma of the lower third of the oesophagus have been enrolled in clinical trials. However, due to small numbers, outcomes for these patients are difficult to extrapolate. Therefore, definitive chemoradiation followed by surveillance is not a standard treatment option for patients with junctional adenocarcinoma, although this strategy may be considered for selected patients with localised disease who do not want to pursue a surgical treatment.

Neoadjuvant approaches are recommended in presence of a locally advanced junctional adenocarcinoma. However, suboptimal staging or emergency procedures may lead to surgery up-front. In these cases, adjuvant chemotherapy should be discussed with the patient, bearing in mind a small survival benefit chemotherapy may bring. Following suboptimal lymphadenectomy or in presence of positive resection margins, adjuvant chemoradiation therapy should be considered, based on the sustained long-term survival benefit demonstrated in the study of primarily enrolled patients with gastric cancer with approximately 20% of patients who had a junctional adenocarcinoma.

Besides elaborating different relevant factors in junctional tumours, the authors provide a set of key take-home messages about assessment, treatment strategies, important prognostic indicators and questions that might be answered by currently ongoing clinical studies.

Last update: 14 April 2016

Prof Cunningham has reported research funds received by his institution from Amgen, AstraZeneca, Bayer, Celgene, Medimmune, Merck Serono, Merrimack and Sanofi.

Dr Fontana has reported no conflicts of interest.