Chemoradiation Therapy: Localized Esophageal, Gastric, and Pancreatic Cancer

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Key points

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    The management of localized gastrointestinal (GI) cancers with definitive intent typically includes multimodality therapy with some combination of surgery, chemotherapy, and radiation.

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    In esophageal and gastroesophageal junction (GEJ) cancers, concurrent chemoradiation should be used both in the preoperative setting and the definitive setting.

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    Surgery is the mainstay of treatment of gastric cancer, and adjuvant therapy with chemotherapy alone and with chemoradiation are both acceptable standards.

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Esophageal and gastroesophageal cancers

CRT for esophageal and GEJ cancers is currently used preoperatively for the surgically resectable population as well as definitively in inoperable patients.

Gastric cancer

Surgery has been, and continues to be, a critical component in the treatment of locally advanced American Joint Committee on Cancer 2010 stages IB–III gastric cancer. Historically, however, despite aggressive surgery, gastric cancer is associated with high locoregional and distant metastatic failure rates.31 How and when to use chemotherapy or CRT remain topics of controversy for the adjuvant management of gastric cancer.

Pancreatic cancer

The role of radiation in pancreatic cancer is highly controversial. Modern randomized controlled trials have suggested a mixed benefit to CRT in both resectable and locally advanced cases.

Summary

The management of localized GI cancers is complex and requires integration of multiple specialties. Patients should be evaluated by a multidisciplinary team before surgery to coordinate care to achieve optimal outcomes. For many GI cancers, such as esophageal and GEJ, preoperative CRT is advocated, whereas for gastric cancer, both perioperative chemotherapy and postoperative CRT strategies are endorsed. The role of CRT for localized pancreatic cancer remains ill defined and hopefully will be

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