2006 - UZ Leuven

his name to this condition through a publication in 1877 in which hereported a series of 27 patients. Already at that time Zenker presumedthat the pouch is the consequence of “forces within the lumen actingagainst a restriction”, a hypothesis that is indeed close to the modernunderstanding of its pathogenesis and remarkable because bothendoscopy and radiology had yet to be invented. However, themechanistic compression theory as a cause of symptoms wouldprevail until far into the 20 th century, thanks to new developments inimaging, endoscopy, manometry, and manofluorography, has betterinsight into the pathogenesis of Zenker’s diverticulum (ZD) emergedand led to fundamental changes in the therapeutic strategy (myotomyof the cricopharyngeal muscle).LERUT T., COOSEMANS W., DECKER G., DE LEYN P., MOONS J.,NAFTEUX P., VAN RAEMDONCK D.: Diagnosis and therapy in advancedcancer of the esophagus and the gastroesophageal junction. Curr.Opin. Gastroenterol., 2006; 22(4): 437-441.Purpose of review: The aim of this article is to discuss recentdevelopments in the diagnosis and treatment with curative option ofadvanced cancer of the esophagus and gastroesophageal junction.Recent findings: Recent data indicate improvement of clinical stagingaccuracy by multi-slice computer tomography, endoscopic ultrasoundwith fine needle aspiration and positron emission tomography, thelatter gaining growing impact as a prognostic indicator. Whencombined with extended lymphadenectomy primary surgery offers 5-year survivals between 25 and 35% for stage III disease. Results ofinduction therapy remain conflicting. While the most recent metaanalysisfavored induction chemoradiotherapy, a subsequentrandomized trial failed to confirm this conclusion. A growing interest inadjuvant chemoradiotherapy is stimulated by promising results from arecent pilot study. Trials investigating definitive chemoradiotherapyindicate a high incidence of locoregional recurrence. The emergingunderstanding of the molecular pathways that govern neoplasticevents are under intense investigation. Results of pilot clinical studieson targeted therapy are expected shortly.Summary: Refinements in staging offer incremental increase ofaccuracy, the impact of positron emission tomography becomingincreasingly important. In locally advanced disease, the debate on theadded value of multimodality therapy remains unsolved as primarysurgery combined with extended lymphadenectomy offers equalresults. New drugs in particular in combination with targeted therapymay offer better perspectives in the near future.105