Oncological Management of Oesophageal and Gastric Cancer

In current clinical practice the majority of patients diagnosed with oesophageal or gastric cancer have metastatic disease at the time of diagnosis. In order to manage these patients successfully, effective systemic treatments are necessary and the impact of these systemic therapies in reducing tumour burden, improving symptoms, quality of life and extending survival in the palliative setting are allimportant. Given the early propensity of these cancers to progress and the potential for dissemination, even in patients with early cancers, local and systemic therapy must be considered along with surgery. The concept of multi-modal treatment is at a welldeveloped stage in oesophago-gastric cancer treatment and best exemplified by neoadjuvant chemo-radio therapy for oesophageal cancer. Adjuvant therapy remains an option in locally advanced cancers. Similar treatments can be used for recurrent disease. Systemic treatments for oesophageal and gastric cancer have evolved from cytotoxic chemotherapies to the more recent emergence of rationally designed targeted therapies which act by inhibiting specific molecular drivers of oncogenesis. They are often used in combination with predictive biomarkers that identify those patients most likely to respond- the precision medicine strategy. Despite their cost, their benefits include reduced toxicity and increased efficacy

Keywords: Adjuvant therapy, Chemo/radio therapy, Chemotherapy, Gastric cancer, Multi-modality treatment, Neo-adjuvant therapy, Oesophageal cancer, Palliative treatment, Performance status, Radiotherapy.