From the Lombardi Comprehensive Cancer Center, Georgetown University Medical Center, Washington, DC
Author's disclosure of potential conflicts of interest is found at the end of this article.
Address reprint requests to Jimmy Hwang, MD, Department of Medicine, Lombardi Comprehensive Cancer Center, Georgetown University Medical Center, 3800 Reservoir Road, N.W., Lombardi Cancer Center, P-426, Washington, DC 20007; e-mail: jh96{at}gunet.georgetown.edu
Overview: Although gastric, esophageal, and gastroesophageal junction cancers are contiguously located, the treatment approach for potentially resectable gastric cancer is distinct from that of esophageal and gastroesophageal junction cancers. This is a function of the anatomy of the organs with different surgical approaches and distinct cancer biology. This difference is highlighted by randomized clinical trial data demonstrating that postoperative chemotherapy, with or without radiation, improves survival in resected gastric cancer compared with observation alone. The role of preoperative therapy is less clear, but randomized clinical trials suggest that preoperative chemotherapy or radiation also improve survival compared with surgery alone. Available data suggest that surgery followed by postoperative therapy may be the preferred approach for patients with resectable gastric cancer, but patient characteristics may also reasonably influence the treatment approach.
