Overview of multimodal therapy for adenocarcinoma of the esophagogastric junction.

The incidence of adenocarcinoma of the esophagogastric junction (AEG) has been rising. There is no standard treatment strategy for locally advanced AEG. The standard surgical treatment of Siewert type I AEG is Ivor-Lewis esophagectomy with mediastinal lymph node dissection. The optimal extent of mediastinal lymph node dissection for Siewert type II or III AEG with esophageal invasion of >3 cm remains unclear. Adjuvant chemotherapy should be added to the treatment of AEG. Many trials have demonstrated the beneficial effect of adjuvant chemotherapy. However, the combinations of chemotherapeutic agents and timing of administration of the drugs remains undefined. Adjuvant chemoradiotherapy has been investigated especially in Western countries. The INT-0116 revealed that adjuvant chemoradiotherapy with surgery is effective for AEG, and the CROSS trial showed that neoadjuvant chemoradiotherapy with surgery is effective for AEG. However, notice should be given to the relatively higher rate of distant metastasis after curative resection of AEG. Several molecular targeted agents have been investigated for the treatment of unresectable advanced AEG. Trastuzumab exhibited a beneficial effect for unresectable advanced AEG with overexpression of HER2. Whether the same effect is true in the adjuvant setting is being investigated. Systemic chemotherapy and surgical resection with adequate lymph node dissection may be more effective than localized treatment of chemoradiotherapy and surgical resection with limited lymph node dissection for locally advanced AEG. Molecular targeted agents may be beneficial for the treatment of locally advanced AEG.