Multimodality therapy for gastroesophageal cancers

Multimodality therapy is the key to the treatment of carcinomas of the gastroesophageal junction. Chemoradiation followed by esophagectomy appears to be the standars therapy at the present time. Selected patients who respond completely to the chemotherapy and radiation are probably the best candidates for esophagectomy. Although extended lymph node dissection is advocated, there are not sufficient data to determine whether the increased morbidity of the procedure is justified by the improvement in outcome for junctional cancers. Early cancers in nonsurgical patients could potentially be treated by endoscopic methods including endoscopic mucosal resection, which permits accurate staging, and photodynamic therapy, which permits treatment of residual premalignant tissue. Palliation of patients with advanced cancers of the gastroesophageal junction is probably best managed with expandable metal stents, although there is some evidence to suggest that thermal methods of palliation may enhance the quality of life in these patients.