Perioperative therapies in esophageal adenocarcinoma and cancer of the esophagogastric junction

Background: While the incidence of squamous cell carcinoma of the esophagus is decreasing in Western countries, there is an increase in adenocarcinomas of the esophagus and gastroesophageal junction (AEG) [42]. Esophageal cancer is the seventh most common cancer worldwide and is associated with one of the highest mortality rates. In Germany, more than 7000 esophageal cancers are newly diagnosed each year [32]. At first presentation, about 60% are in a resectable stage [25]. Objective: This article aims to present current guideline-based treatment and new developments in the perioperative treatment of adenocarcinomas of the esophagus and gastroesophageal junction. Materials and methods: This work is based on a topic-related selective literature search in the PubMed database, ClinicalTrials.gov, and current guidelines. Results: According to current guidelines, preoperative radiochemotherapy according to the CROSS regimen and perioperative chemotherapy with FLOT (5-fluorouracil, folinic acid, oxaliplatin, docetaxel) are possible treatment options for perioperative treatment of advanced resectable AEG and esophageal carcinomas (>= T2 and/or N + tumors). Current results (ESOPEC) show a clear advantage of perioperative chemotherapy. In order to further improve perioperative chemotherapy, studies are investigating the addition of checkpoint inhibitors (MATTERHORN, KEYNOTE-585) or other targeted therapies such as HER2-targeting antibodies (HERFLOT, INNOVATION). However, it is still questionable whether the hereby achieved improvement in the rate of pathologically complete remissions also translates into longer survival.