EGJ and esophageal cancers: Choosing induction therapy so as to err on the side of overtreatment rather than undertreatment when staging is imperfect

摘要

Esophagogastric adenocarcinoma has long been noted to encompass a group of diseases that are diverse in their epidemiology, causative factors, and pathology-and for which, to date, an equally diverse array of treatment options and therapies have been tried. In many centers, treatment strategies and selection of the oncology team might vary with a shift of a few centimeters in tumor location. With that in mind, this commentary reflects a thoracic surgery point of view, if such a thing exists. What underscores any attempt to successfully treat, or at best manage, esophagogastric junction (EGJ) and esophageal tumors is accurate staging. When the cancer involves lymph nodes, it is accepted that surgery-only strategies will usually fail. However, there is increased morbidity and mortality risk with induction therapy, and some work has shown that excess mortality might result with inappropriate application of induction therapy. [1] While randomized clinical trials comparing induction therapy (usually chemoradiation) to "up-front" surgery have been important in formulating our current protocols, it can be challenging to generalize the results of positive trials when there is great variability in staging within and between clinical trials.