Selecting Neoadjuvant Strategies for Esophageal and GEJ Adenocarcinoma Across Multidisciplinary Practices
Experts discuss tailored approaches to neoadjuvant therapy for esophageal and G-junction cancers, emphasizing the importance of multidisciplinary care.
This segment explores how clinicians individualize neoadjuvant strategies for gastroesophageal junction and tubular esophageal adenocarcinomas. A surgical perspective emphasizes two consistent priorities in locally advanced disease. First, most patients are at high risk for systemic recurrence, which strengthens the rationale for effective systemic therapy. Second, conventional staging with endoscopic ultrasound and PET can underestimate local extent, underscoring the importance of preoperative treatment to optimize resectability. The panel discusses why many centers prefer to deliver a substantial portion of chemotherapy or chemoimmunotherapy before surgery, given the challenges of providing full dose systemic therapy in the postoperative setting. For tubular esophageal tumors where achieving clear margins may be difficult, radiation in the neoadjuvant setting is considered more strongly. In contrast, for selected gastroesophageal junction tumors where an R0 resection appears feasible, chemotherapy or chemoimmunotherapy without radiation can be appropriate. A community oncology perspective then details how multidisciplinary tumor boards and coordinated referrals structure these decisions in real world practice.
