Multimodal treatment of adenocarcinoma of the esophagogastric junction

Background. The prognosis of resectable adenocarcinoma of the esophagogastric junction is critical.ObjectiveTo outline the current evidence for multimodal treatment concepts and to give evidence-based treatment recommendations. Material and methods. A literature search was carried out for clinical phase II and III studies within the past 25 years via PubMed. Reviw of the current German, European and North American guidelines. Results. Multimodal treatment concepts are recommended for improving survival outcomes of patients with resectable adenocarcinoma of the esophagogastric junction. These concepts include surgery, chemotherapy and optionally radiotherapy. The relative risk reduction for the endpoint death is improved by 20-35% when applying multimodal treatment as compared to surgery alone. This translates into a 5-year overall survival rate of 33% after surgery alone as compared to 43% with neoadjuvant therapy in the pivotal CROSS study. Prospective controlled trials showed that both neoadjuvant chemoradiotherapy and also perioperative chemotherapy can be safely administered in experienced centers and lead to improved overall survival and do not increase postoperative mortality. Conclusion. According to current scientific evidence, either preoperative chemoradiotherapy or perioperative chemotherapy are recommended for resectable adenocarcinoma of the gastroesophageal junction.