Perioperative treatment for resectable esogastric adenocarcinoma

Gastric cancer is the 6th most common cancer in the world. Gastric adenocarcinomas can be divided into two groups: gastroesophageal junction adenocarcinomas and distal gastric adeno-carcinomas, with different risk factors and potentially different therapeutic strategies. Thera-peutic strategy for esogastric adenocarcinoma is multimodal. Gastric adenocarcinomas are managed with surgery and peri-operative chemotherapy. Gastroesophageal junction adenocar-cinomas can either be treated surgically after neoadjuvant chemoradiotherapy or in the same way than gastric adenocarcinomas. There is currently no evidence of superiority of either treatment strategy. Recently, nivolumab has been validated as an adjuvant therapy for patients with esophageal cancer who received preoperative chemoradiotherapy and had residual tumor on the surgical specimen. In the absence of preoperative treatment, adjuvant chemoradiotherapy or chemotherapy should be discussed on a patient-by-patient basis. Currently, there is not indication for targeted therapies, nor for adapting postoperative treatment according to the response to preoperative treatment. The only validated indication for immunotherapy is as adjuvant treatment of esophageal cancer, but many studies are ongoing and may change practices in the future. The objective of this review is to synthesize the literature concerning the management of localized esogastric adenocarcinoma.

Automated summary

Gastric cancer is one of the most common cancers worldwide, and it can be divided into two groups: gastroesophageal junction adenocarcinomas and distal gastric adenocarcinomas. The treatment strategies for these cancers differ, with multimodal therapy for gastroesophageal junction adenocarcinomas and surgery and peri-operative chemotherapy for gastric adenocarcinomas. There is currently no evidence to support the superiority of one treatment strategy over the other. Nivolumab has recently been validated as an adjuvant therapy for esophageal cancer patients who have residual tumor after preoperative chemoradiotherapy. Adjuvant chemoradiotherapy or chemotherapy may be considered on a case-by-case basis for patients without preoperative treatment.