RESUMEN
BACKGROUND: The treatment of localized esophageal cancer has been debated controversially over the past decades. Neoadjuvant treatment was used empirically, but evidence was limited due to the lack of high-quality confirmatory studies. Meanwhile, data have become much clearer due to recently published well-conducted randomized controlled trials and meta-analyses. METHODS: Neoadjuvant and perioperative platinum fluoropyrimidine-based combination chemotherapy has now an established role in the treatment of stage II and stage III esophageal adenocarcinoma and cancer of the esophago-gastric junction. Neoadjuvant chemoradiation is now the standard of care for treating stage II and stage III esophageal squamous cell cancer and can also be considered for treating esophageal adenocarcinoma. RESULTS: Patients with esophageal squamous cell cancer treated with definitive chemoradiation achieve comparable long-term survival compared with surgery. Short-term mortality is less with chemoradiation alone, but local tumor control is significantly better with surgery. CONCLUSION: This expert review article outlines current data and literature and delineates recommendable treatment guidelines for localized esophageal cancer.
Asunto(s)
Adenocarcinoma/diagnóstico , Adenocarcinoma/terapia , Carcinoma de Células Escamosas/diagnóstico , Carcinoma de Células Escamosas/terapia , Neoplasias Esofágicas/diagnóstico , Neoplasias Esofágicas/terapia , Adenocarcinoma/mortalidad , Adenocarcinoma/patología , Carcinoma de Células Escamosas/mortalidad , Carcinoma de Células Escamosas/patología , Quimioradioterapia , Terapia Combinada , Quimioterapia Combinada , Neoplasias Esofágicas/mortalidad , Neoplasias Esofágicas/patología , Esofagectomía , Humanos , Metástasis Linfática/patología , Terapia Neoadyuvante , Estadificación de Neoplasias , Medición de RiesgoRESUMEN
Metabolic imaging and early response assessment by positron emission tomography (PET) are gaining importance in guiding treatment of localised and metastatic gastrointestinal tumours. During a workshop organised by the European Organisation of Research and Treatment of Cancer (EORTC) Gastrointestinal Tract Cancer Group the most relevant research questions, methodological aspects and unmet clinical needs in this disease were discussed. Potential future trials were drafted. This paper reviews the lectures and discussions held during this workshop and summarises the action points for the further investigation of metabolic imaging to guide treatment in gastrointestinal tumours.