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.