Current Standards and Controversies in Multidisciplinary Management of Locoregional Gastroesophageal Junction Tumors.

PURPOSE OF REVIEW

There has been controversy in the management of gastroesophageal (GE) junction cancers with pre-operative chemoradiation and peri-operative chemotherapy as accepted practices. We aim to assess and compare the defining trials establishing current standards of care and discuss future directions seeking to further improve patient-centered outcomes in GE junction cancers.

RECENT FINDINGS

Over the last two decades, several large Phase III randomized trials have been conducted including GE junction cancers, showing superiority of 1) pre-operative chemoradiation over surgery (CROSS) and 2) peri-operative chemotherapy with FLOT over CROSS without radiotherapy (FLOT 4). While NEO-Aegis suggested equipoise between the CROSS vs. peri-operative chemotherapy, the recently presented ESOPEC trial demonstrated superiority of peri-operative FLOT versus CROSS in esophagus and GE junction adenocarcinomas. Based on the ESOPEC trial, peri-operative chemotherapy with FLOT appears to be a preferred regimen for patients with resectable GE junction adenocarcinomas in patients able to receive FLOT. There is evidence in support of other practices, such as induction chemotherapy, pre-operative chemoradiation, definitive chemoradiation for those not fitting ESOPEC criteria. Chemoradiation ± chemotherapy with non-operative intent represents a promising strategy for patients seeking organ preservation, and ongoing studies will better define its feasibility and long-term outcomes.