How would you approach neoadjuvant chemoradiation in a patient with a history of Crohn’s disease diagnosed with regional lymph node-positive esophageal adenocarcinoma of the GE junction?

Remember that GEJ was evaluated in MAGIC (and more recently, FLOT4) trial. From FLOT4, about 25% of patients were Siewert I, while another 33% were Siewert II/III.

Therefore, if concerns about the severity of Crohn's (and potential RT toxicity) are a significant issue, a reasonable treatment paradigm...

The plan of care would vary, based on the extent of Crohn's disease and if the disease is active or in remission. Either way, the dose for preop would be like the CROSS trial and the plan should be to limit small bowel dose and volume as much as possible.