In patients with esophageal or GEJ cancer who start with FLOT but receive only 1 or 2 cycles due to intolerance, would you switch to neoadjuvant chemoradiation (i.e., CROSS) or proceed to surgery?

In the randomized ESOPEC trial, 87% of patients assigned to FLOT completed all four planned preoperative cycles. However, this question reflects a common real-world scenario where treatment-limiting toxicity prevents completion of perioperative chemotherapy.

In this setting, switching to neoadjuvant ...