Executive Summary of the American Radium Society (ARS) Appropriate Use Criteria (AUC) for Operable Esophageal and Gastroesophageal Junction Adenocarcinoma: Systematic Review and Guidelines. Journal Article


Authors: Anker, CJ; Dragovic, J; Herman, JM; Bianchi, NA; Goodman, KA; Jones, WE; Kennedy, TJ; Kumar, R; Lee, P; Russo, S; Sharma, N; Small, W; Suh, WW; Tchelebi, L; Jabbour, SK
Article Title: Executive Summary of the American Radium Society (ARS) Appropriate Use Criteria (AUC) for Operable Esophageal and Gastroesophageal Junction Adenocarcinoma: Systematic Review and Guidelines.
Abstract: PURPOSE: Limited guidance exists regarding the relative effectiveness of treatment options for non-metastatic, operable patients with adenocarcinoma of the esophagus or gastroesophageal junction (GEJ). In this systematic review, the American Radium Society (ARS) gastrointestinal expert panel convened to develop Appropriate Use Criteria (AUC) evaluating how neoadjuvant and/or adjuvant treatment regimens compared to each other, surgery alone, or definitive chemoradiation in terms of response to therapy, quality of life (QoL), and oncologic outcomes. MATERIALS AND METHODS: PRISMA systematic review methodology was employed to develop an extensive analysis of peer-reviewed phase IIR and phase III randomized controlled trials as well as meta-analyses found within the Ovid Medline, Cochrane Central and Embase databases between 2009-2019. This information was used to inform the expert panel who then rated the appropriateness of various treatments in four broadly representative clinical scenarios through a well-established consensus methodology (modified Delphi). RESULTS: For a medically operable patient with a cT3 or N+ and M0 adenocarcinoma of the esophagus or GEJ (Siewert I-II) the panel most strongly recommends neoadjuvant chemoradiation. For a cT2N0M0 patient with high risk features, the panel recommends that neoadjuvant chemoradiation is usually appropriate. For patients found to have pathologically involved nodes (pN+) who did not receive any neoadjuvant therapy, the panel recommends that adjuvant chemoradiation is usually appropriate. These guidelines assess the appropriateness of various dose-fractionating schemes and target volumes. CONCLUSIONS: Chemotherapy and/or radiation regimens for esophageal cancer are still evolving with many areas of active investigation. These guidelines are intended for the use of practitioners and patients who desire information about the management of operable esophageal adenocarcinoma.
Journal Title: International journal of radiation oncology, biology, physics
ISSN: 1879-355X; 0360-3016
Publisher: Elsevier Inc  
Date Published: 2020
LUC Authors
  1. William Small
    153 Small