Multimodality treatment strategies

Multimodality treatment strategies

Results from surgical resection alone have improved. Mortality from surgery is less than 5% in dedicated centres. The long term prognosis remains suboptimal. Since the 1990s, multi- modality treatment has gained impetus and is now routine for advanced disease. Neoadjuvant therapy is more popular than postoperative therapy , in the form of either neoadjuvant chemotherapy or chemoradiotherapy . In OGJ cancers, peri operative (pre- and postoperative chemotherapy) has advocates. The optimal regimen remains controversial. Recent advances in immunotherapy add to the armamentarium. Overall, after treatment in a multimodality prog ramme, a 5-year survival rate of 40–50% is expected. The disease stage and the ability to perform an R0 resection are the most powerful predictors of outcome.