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.

Source: World Journal of Gastroenterology