How do you treat locally advanced, operable, Siewert 3 GE junction adenocarcinomas?

This remains an area of controversy, but perhaps not as controversial as Siewert type II tumors. Siewert type III tumors are staged as gastric cancers in the AJCC 8^th edition. In addition, they are more histologically similar to gastric cancer and have patterns of nodal spread like gastric cancer as well (Pedrazzani et al.). Accordingly, our institution treats Siewert type III tumors like gastric cancer with perioperative chemotherapy, preferably FLOT. There is an excellent review article from M...

Bryan -

No one else is answering, so I'll give your question a go. If I recall, the Siewart-Stein classification looks at distance from the GE-junction with a 3 being pretty much firmly within the stomach. GE Junction can be treated with MAGIC chemotherapy and surgery or neoadjuvant chemoradiation and surgery. My guess is big studies included both. Right now, to my knowledge, there is not a right or wrong answer. The median survial for all these studies are pretty close to one another, but most ...

Siewert type III lesions - subcardial carcinoma with the tumor epicenter between 2 cm and 5 cm below the esophagogastric junction, which infiltrates the esophagogastric junction and lower esophagus from below - are considered gastric cancers. Surgical treatment follows general oncology principles: resect to negative margins with complete lymph node dissection, and the extent of resection often extends more proximal onto the esophagus in addition to the total/subtotal gastrectomy. (Tang A et al. ...