LAUSR

BACKGROUND Neoadjuvant chemotherapy (nCT) or chemoradiotherapy (CRT) are accepted standards of care for the management of adenocarcinoma (AC) of esophagus and gastro-esophageal junction (GOJ). SUMMARY The MRC-OEO2 study established the role of 2 cycles of neoadjuvant cisplatin/fluoropyrimidine (FP). More recently, the FLOT-AIO4 study demonstrated the superiority of peri-operative FLOT chemotherapy (5FU, oxaliplatin and docetaxel) compared to ECX (epirubicin, cisplatin and capecitabine) regime. The results from the pivotal CROSS study established neoadjuvant CRT as a new standard of care in OG cancer. The survival benefit observed in FLOT and CROSS studies are similar [FLOT- HR 0.75 (0.62-0.92); CROSS - 0.741 (0.55-0.98)]. KEY MESSAGES Both nCT and nCRT have been shown to be associated with survival benefit compared to surgery alone. We have performed a comprehensive review of the available evidence to define the optimum treatment algorithm and identify specific patient sub-groups who may be appropriate for the use of one or more of these neoadjuvant options.