Treatment of Locally Advanced Resectable Adenocarcinoma of the Oesophagus and Oesophagogastric Junction
Clinical scenario
This protocol applies to patients with locally advanced, surgically resectable adenocarcinoma (AC) of the oesophagus or oesophagogastric junction (OGJ) — a presentation in which disease extent warrants systemic therapy in combination with surgery rather than surgery alone.
Treatment approach
A combined-modality strategy — neoadjuvant chemoradiotherapy or perioperative chemotherapy — followed by surgical resection is recommended as standard of care for this presentation.
The specific regimen, sequencing, and criteria are detailed in the full structured protocol.
References
DOI: 10.1016/j.annonc.2022.07.003
- Based on the results of CROSS, preoperative CRT can be recommended as one standard of care for locally advanced AC of the oesophagus and OGJ.
- Patients with resectable, locally advanced oesophageal AC or OGJ cancer should be treated with neoadjuvant CRT based on the CROSS regimen or perioperative ChT (FLOT) followed by surgery [I, A; ESMO-MCBS v1.1 score: A].
- Weekly carboplatin–paclitaxel combined with radiation to a dose of 41.4 Gy in 23 fractions followed by oesophagectomy showed improved survival compared with surgery alone for both SCC and AC.
- The phase II/III FLOT4-AIO trial compared perioperative ECF with four preoperative and four post-operative cycles of 5-FU–leucovorin–oxaliplatin–docetaxel (FLOT), and showed an OS benefit for FLOT.
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