Abstract

Esophageal adenocarcinoma (EAD) has been recently described as ‘the silent epidemic’ because of its rapidly rising incidence. Two-thirds of patients with esophageal adenocarcinoma present with locally advanced disease. In spite of recent advances in cancer therapy, the treatment of locally advanced esophageal and gastroesophageal junction (GEJ) adenocarcinoma remains challenging. Current standard of care for fit patients with locally advanced esophageal adenocarcinoma is trimodality therapy with concurrent platinum-based chemotherapy and ionizing radiation followed by surgical resection. Numerous modifications of the surgical technique are being practiced, but in general Ivor Lewis esophagectomy with celiac and peri-esophageal lymph node dissection is considered standard of care. The depth of invasion (T stage), number of involved lymph nodes, pathologic complete response to preoperative therapy, number of resected lymph nodes at the time of surgery, and preoperative nutritional status are important prognostic factors. No postoperative therapy has been shown to improve outcomes in patients with residual disease at the time of surgery. A number of newer agents including EGFR tyrosine kinase inhibitors, monoclonal antibodies against EGFR, HER2 targeted therapy, immunotherapy, and anti-angiogenic agents are currently being evaluated to improve the outcomes of these patients. The optimum management of GEJ adenocarcinoma remains debated, however currently available evidence suggests that it should be treated as esophageal rather than gastric tumors except for type III tumors, which can be, treated as gastric carcinoma with perioperative chemotherapy.

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