Evolution of preoperative and postoperative therapies in the management of localized gastroesophageal cancers.

Recent changes in the epidemiology of gastroesophageal cancers in the United States and many parts of Europe require reassessment of traditional surgical and adjuvant treatment approaches to these tumors. Careful preoperative staging and classification aid in the selection of appropriate treatments. While molecular genetic methods to distinguish esophageal from gastric tumor origins are awaited, a practical system that classifies adenocarcinomas of the esophagogastric junction into one of three types is contributing to the understanding of these tumors as well as determining the best surgical approach. Treatments that have significantly improved outcomes over those achieved with surgery alone include neoadjuvant chemotherapy with epirubicin, cisplatin, and 5-fluorouracil (ECF), or postoperative chemoradiotherapy using 5-fluorouracil, leucovorin, and 45 Gy radiation. This paper reviews studies of preoperative and postoperative chemotherapy and radiotherapy in patients with gastroesophageal cancers, as well as studies of the optimal extent of lymph node dissection.