Esophagogastric junction adenocarcinoma: Preoperative chemoradiation or perioperative chemotherapy?

Table 1 Relevant characteristics of current available neoadjuvant and perioperative therapies for esophagogastric junction tumors

Study	Year	Number of patients	Included patients	Groups	EGJ tumors	Outcomes
MAGIC	2006	503	Gastric, lower esophagus, and EGJ tumors	ECF + Surgery vs Surgery alone	11%	Perioperative chemotherapy improves overall survival
ACCORD	2011	224	Gastric, lower esophagus and EGJ tumors	CF + Surgery vs Surgery alone	64%	Perioperative chemotherapy improves overall survival, disease-free survival and resecability
CROSS	2012	366	Esophageal and EGJ tumors	Chemoradiation + Surgery vs Surgery alone	22%	Chemoradiotherapy improves overall survival
FLOT	2019	716	Gastric and EGJ tumors	FLOT vs ECF	56%	FLOT improves overall survival

EGJ: Esophagogastric junction; MAGIC: the British Medical Research Council Adjuvant Gastric Infusional Chemotherapy; ECF: Epirubicin, cisplatin, and fluorouracil; CROSS: ChemoRadiotherapy for Oesophageal cancer followed by Surgery Study.

Table 2 Potential advantages (+) and disadvantages (-) of preoperative chemoradiation and perioperative chemotherapy

Preoperative chemoradiotherapy	Perioperative chemotherapy
+ Better loco-regional control	+ Better systemic control
+ High rates of complete pathologic response	+ No adverse events from radiotherapy
- Poorer response in adenocarcinoma (increased radiation sensitivity in squamous cell carcinoma)	- Poorer loco-regional control
- Radiation-induced changes in surgical field	- Many patients are not able to complete the postoperative regimen