Esophageal Adenocarcinoma Methods and Protocols

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Alfred K. Lam (ed.), Esophageal Adenocarcinoma: Methods and Protocols, Methods in Molecular Biology, vol. 1756,
https://doi.org/10.1007/978-1-4939-7734-5_3, © Springer Science+Business Media, LLC 2018

Chapter 3

Chemotherapy for Esophageal Adenocarcinoma

Ka-On Lam and Dora L. W. Kwong

Abstract

Esophageal and esophagogastric junction adenocarcinoma is a distinct entity from esophageal squamous
cell carcinoma with respect to etiology and biology despite sharing the same anatomical location. While
most international treatment guidelines recommend a similar management strategy for both esophageal
squamous and adenocarcinoma histologies, the evidence for treating adenocarcinoma are indeed more
often extrapolated from that of gastric carcinoma. In this chapter, the best evidences for the management
of this distinct disease with chemotherapy in both curative and palliative clinical settings are presented.

Key words Esophageal adenocarcinoma, Esophagogastric junction adenocarcinoma, Chemotherapy,

Preoperative, Perioperative, Palliative

1 Introduction

Surgery is the standard of care for esophageal adenocarcinoma but

long-term survival for patients after surgery alone remains uncom-

mon for locoregionally advanced disease due to high risk of relapse

at both locoregional and distant sites [ 1 ]. Chemotherapy with or

without radiotherapy prior to or during perioperative period has

been shown to improve clinical outcomes. On the other hand, for

the majority of patients who present with advanced inoperable or

metastatic disease, systemic treatment with chemotherapy as well

as target therapy in selected patients represents a reasonably effec-

tive treatment for palliation. Adenocarcinoma of the esophagus

and the esophagogastric junction represents a unique subgroup

and is distinct in etiology and geographical distribution from squa-

mous cell counterpart [ 2 – 6 ]. With regard to clinical study, they are

often included in studies of both gastric and esophageal carcinoma,

indeed often mingled with gastric carcinoma, instead of having

specific studies on their own. As a result, clinical evidence and con-

sequently relevant treatment guidelines are empirical rather than

precise for them: they are treated in a similar manner as esophageal

squamous cell carcinoma or gastric adenocarcinoma [ 7 , 8 ]. In this