Gastroesophageal junction carcinoma multimodal treatment: Standards, debate and new therapeutic options

Carcinoma of the gastroesophageal junction (GEJ) may represent a specific histopathological and biologic entity. Most clinical trial data available have emerged by including GEJ cancer either in gastric or esophageal cancer studies. Although surgery and chemotherapy are considered the standard treatment for the disease, numerous questions remain unanswered and there is still much debate. In this article, we discuss the challenges in how to approach an optimal multidisciplinary treatment including surgery, timing (preoperative, postoperative, perioperative) and chemotherapeutic regimen, radiotherapy and targeted therapy. More recent advances in genetics, genomics, and next-generation sequencing (NGS) technologies for whole and exome cancer genome sequencing and systems biology approaches are also discussed. All of these new translational research approaches reflect a current worldwide consensus on the urgent need to improve the poor outcome of patients with GEJ cancer. Whether novel biomarkers, together with a new generation of individual tumor-guided agents, could be developed to achieve personalized management of this highly fatal disease is also addressed. © 2011 Expert Reviews Ltd