How to treat gastroesophageal adenocarcinom patients?

Gastroesophageal adenocarcinomas have a poor prognosis. However, numerous randomized clinical trials (RCT) have evaluated, and continue to evaluate, the survival benefit of various treatment regimens. Surgery remains standard care for early stage esophageal cancer and gastric cancer. However, RCTs have also shown a survival benefit associated with chemotherapy and chemoradiation. Few studies have examined community-based patterns of care for these cancers. A study of esophageal adenocarcinoma and squamous cell carcinoma patients diagnosed between 1996 and 1999 found that chemoradiation without surgery was most frequent therapy, although patients given chemoradiation followed by surgery had better survival compared to chemoradiation alone. Research suggests community-based use of treatment and the observed survival of patients in the community can vary depending on clinical and non-clinical factors.

A research study to be published on 28 May 2008, in the World Journal of Gastroenterology investigates treatments received and factors that influence the receipt of treatment in gastroesophageal adenocarcinoma.

The study findings indicate the relatively low use of RCT-approved treatments in US community-based practice despite their demonstrated survival benefits. Investigators report lower mortality among patients with esophageal and stomach adenocarcinoma who received chemotherapy and significant disparities in terms of age in treatment receipt. The findings indicate that US community physicians take an individualized approach in treating adenocarcinoma of the esophagus, gastric cardia, and stomach; differentiating gastroesophageal adenocarcinoma as two distinct entities (i.e., esophageal and stomach) and use different treatment strategies and chemotherapeutic agents for each, while patients with gastric cardia adenocarcinoma are treated with a mixture of agents employed for the other two anatomic sites. The study concludes that improvements in community-based treatment of gastroesophageal adenocarcinoma will require better differentiation of treatments by anatomic sites and more extensive incorporation of those treatments proven effective in clinical trials.

Future RCTs should be designed and appropriately powered to account for differences related to the anatomic site or origin of the tumor as well as the underlying tumor biology.

Reference: Cronin-Fenton DP, Mooney MM, Clegg LX, Harlan LC. Treatment and survival in a population-based sample of patients diagnosed with gastroesophageal adenocarcinoma.World J Gastroenterol 2008; 14(20): 3165-3173
http: //www.wjgnet.com/1007-9327/14/3165.asp

Correspondence to: Dr. Linda Harlan, Applied Research Program, DCCPS, National Cancer Institute, 6130 Executive Blvd MSC 7344, Bethesda MD 20892-7344, United States. lh50w@nih.gov
Telephone: +1-301-4967085 Fax: +1-301-4353710

World Journal of Gastroenterology (WJG), a leading international journal in gastroenterology and hepatology, has established a reputation for publishing first class research on esophageal cancer, gastric cancer, liver cancer, viral hepatitis, colorectal cancer, and H pylori infection and provides a forum for both clinicians and scientists. WJG has been indexed and abstracted in Current Contents/Clinical Medicine, Science Citation Index Expanded (also known as SciSearch) and Journal Citation Reports/Science Edition, Index Medicus, MEDLINE and PubMed, Chemical Abstracts, EMBASE/Excerpta Medica, Abstracts Journals, Nature Clinical Practice Gastroenterology and Hepatology, CAB Abstracts and Global Health. ISI JCR 2003-2000 IF: 3.318, 2.532, 1.445 and 0.993. WJG is a weekly journal published by WJG Press. The publication dates are the 7th, 14th, 21st, and 28th day of every month. WJG is supported by The National Natural Science Foundation of China, No. 30224801 and No. 30424812, and was founded with the name of China National Journal of New Gastroenterology on October 1, 1995, and renamed WJG on January 25, 1998.