Role of Multimodality Treatment for Cancer of the Esophagus and Gastroesophageal Junction
Publication Date: November 1, 2014
Recommendations
Patients with potentially curable, locally advanced esophageal cancer should be cared for in a multidisciplinary setting. (B, Class I)
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Restaging studies after neoadjuvant therapy are recommended before resection to rule out interval development of distant metastatic disease. (B, Class I)
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Endoscopic ultrasound restaging for residual local (mural) disease is inaccurate and can be omitted. (B, Class IIa)
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A positron emission tomography scan is recommended for restaging after neoadjuvant therapy to detect interval development of distant metastatic disease. (B, Class IIa)
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Radiotherapy as monotherapy before resection is not recommended. (A, Class III)
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Neoadjuvant platinum-based doublet chemotherapy alone is beneficial before resection for patients with locally advanced esophageal adenocarcinoma. (A, Class IIa)
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Neoadjuvant chemoradiation therapy should be used for locally advanced squamous cell cancer and either neoadjuvant chemotherapy or chemoradiation therapy for locally advanced adenocarcinoma; multimodality therapy has advantages over surgical resection alone. (A, Class IIa)
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After neoadjuvant therapy, patients without metastatic disease, in whom surgical resection can be safely performed, should receive esophageal resection. (A, Class I)
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Patients with adenocarcinoma who have not received neoadjuvant therapy should be considered for adjuvant chemoradiotherapy if the pathologic specimen reveals regional lymph node disease. (B, Class IIa)
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Multimodality Care
Patients with potentially curable, locally advanced esophageal cancer should be cared for in a multidisciplinary setting. (B, Class I)
316161
Restaging
Restaging studies after neoadjuvant therapy are recommended before resection to rule out interval development of distant metastatic disease. (B, Class I)
316161
Endoscopic ultrasound restaging for residual local (mural) disease is inaccurate and can be omitted. (B, Class IIa)
316161
A positron emission tomography scan is recommended for restaging after neoadjuvant therapy to detect interval development of distant metastatic disease. (B, Class IIa)
316161
Neoadjuvant RT
Radiotherapy as monotherapy before resection is not recommended. (A, Class III)
316161
Neoadjuvant CT
Neoadjuvant platinum-based doublet chemotherapy alone is beneficial before resection for patients with locally advanced esophageal adenocarcinoma. (A, Class IIa)
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Neoadjuvant CRT
Neoadjuvant chemoradiotherapy should be used for locally advanced squamous cell cancer and either neoadjuvant chemotherapy or chemoradiotherapy for locally advanced adenocarcinoma; multimodality therapy has advantages over operation alone. (A, Class IIa)
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Value of Surgical Resection After Neoadjuvant Therapy
After neoadjuvant therapy, patients without metastatic disease, in whom surgical resection can be safely performed, should receive esophageal resection. (A, Class I)
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Adjuvant Therapy
Patients with adenocarcinoma who have not received neoadjuvant therapy should be considered for adjuvant chemoradiotherapy if the pathologic specimen reveals regional lymph node disease. (B, Class IIa)
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Recommendation Grading
Disclaimer
Overview
Title
Role of Multimodality Treatment for Cancer of the Esophagus and Gastroesophageal Junction
Authoring Organization
Society of Thoracic Surgeons
Publication Month/Year
November 1, 2014
Supplemental Implementation Tools
Document Type
Guideline
External Publication Status
Published
Country of Publication
US
Document Objectives
This is one of a series of guidelines from the Task Force of the General Thoracic Workforce of The Society of Thoracic Surgeons (STS) focusing on the management of esophageal cancer. This article addresses the role of multimodality therapy in the treatment of this disease.
Inclusion Criteria
Male, Female, Adult, Older adult
Health Care Settings
Hospital, Operating and recovery room
Intended Users
Nurse, nurse practitioner, physician, physician assistant
Scope
Treatment, Management
Diseases/Conditions (MeSH)
D000230 - Adenocarcinoma, D004938 - Esophageal Neoplasms
Keywords
Esophageal cancer, Gastroesophageal cancer
Source Citation
The Society of Thoracic Surgeons Practice Guidelines on the Role of Multimodality Treatment for Cancer of the Esophagus and Gastroesophageal Junction
Little, Alex G. et al.
The Annals of Thoracic Surgery, Volume 98, Issue 5, 1880 - 1885
Methodology
Number of Source Documents
38
Literature Search Start Date
June 1, 2012
Literature Search End Date
April 1, 2014