When would you treat patients with esophageal adenocarcinoma with neoadjuvant chemotherapy alone such as detailed in the UK MRC OE05 trial?
Taking into account the overlap between treatment regimens for esophageal and gastric cancers, in what clinical context might you feel comfortable treating patients with neoadjuvant chemotherapy alone and avoid post-operative treatment? Would an R0 resection and complete pathologic response be sufficient? Would any residual disease prompt some adjuvant treatment?
2 Answers
Mednet MemberInvited Expert
Medical Oncology · Memorial Sloan Kettering Cancer Center
Answered on
This is an excellent question with no clear data to provide a direct answer. I think we all acknowledge a) that pre-operative chemotherapy is easier to administer than post-operative chemotherapy and that b) there is zero biological rationale to take the same chemotherapy and split it up before and ...
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Mednet MemberInvited Expert
Medical Oncology · Memorial Sloan Kettering Cancer Center
Answered on
Our institutional paradigms are consistent with NCCN guidelines, where we treat Siewert Type I/II tumors as esophageal cancer and Siewert Type III as gastric cancer. The broader perspective is that the R0 resection rate for tumors with significant involvement of the GEJ is only about 70% and chemora...
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