Adjuvant and neoadjuvant therapeutic principles have in recent years received increasing attention in the management of @entity1 with @entity189 of the upper gastrointestinal tract. A series of randomized prospective trials has demonstrated that adjuvant postoperative radiation or chemotherapy does not result in a convincing survival advantage after complete @entity5 resection in @entity356 . The available data on the role of neoadjuvant preoperative therapy in these @entity1 as yet permit no conclusion. While neoadjuvant therapy may reduce the @entity5 mass in a substantial portion of @entity1 , a series of randomized controlled trials has shown that, compared to primary resection, a multimodal approach does not result in a survival benefit in @entity1 with loco-regional, i.e. potentially resectable, @entity5 . In contrast, in @entity1 with locally advanced @entity5 , i.e. @entity5 for which complete removal with primary surgery appears unlikely, neoadjuvant therapy increases the chance for complete @entity5 resection on subsequent surgery. However, only @entity1 with objective histopathologic response to preoperative therapy appear to benefit from this approach. Compared to preoperative chemotherapy alone, combined radio-chemotherapy increases the rate of response, particularly in @entity1544 , but may also increase postoperative morbidity and mortality. Neoadjuvant therapy should therefore currently only be performed in experienced centers within the context of prospective clinical trials. The identification of factors that would allow prediction of response to neoadjuvant or adjuvant therapy is the focus of ongoing studies.

[Multimodal therapy of XXXX of the upper gastrointestinal tract].

@entity1 :: ('9606', 'Species') :: ['patients'] @entity5 :: ('MESH:D009369', 'Disease') :: ['tumor', 'tumors'] @entity189 :: ('MESH:D002277', 'Disease') :: ['carcinoma'] @entity1544 :: ('MESH:D018307', 'Disease') :: ['squamous cell esophageal cancer'] @entity356 :: ('MESH:D013274', 'Disease') :: ['gastric or esophageal cancer']
@entity5 :: (MESH:D009369,Disease) :: ['tumors']
