How do you treat locally advanced GE junction adenocarcinoma extending to the esophagus and cardia when the Siewert Type is indistinguishable between 2 and 3?

There is no "correct" answer to this question as both relevant trials seemed to have improved outcomes with this type of disease, so either approach would be acceptable.

However, I think one has to keep in mind that there are (at least) 2 factors that would drive a decision. One is biology and the other is anatomy. FLOT addresses the biology but not the anatomy. The reason to use RT in esophageal cancer relates to the anatomy and the fact that the esophagus does not have a serosa, and so obtain...

When there is question about the epicenter of the tumor, it may be worthwhile to re-scope the patient, particularly if the original EGD was done at an outside institution and available images not informative. We have had many scenarios where a tumor was reported as esophageal/GE junction however, upon re-scoping, turned out to be in the gastric cardia.

That being said, if the epicenter of the tumor truly cannot be discerned between Siewert II and III, then either treatment per GE junction cancer...