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Topics:
Radiation Oncology • Gastrointestinal Cancers • Esophageal Cancer • Medical Oncology • ASCO 2024
Given the results of ESOPEC from ASCO 2024, for which patients with resectable esophageal adenocarcinoma would you favor neoadjuvant chemoradiation?
ESOPEC compared perioperative FLOT vs neoadjuvant chemoradiation per the CROSS trial, and showed superior OS with perioperative FLOT. What concerns do you have, if any, about offering perioperative FLOT en lieu of neoadjuvant chemoradiation?
Answer from: Radiation Oncologist at Academic Institution
It is a great question and something that I think all of us are still wrestling to digest and readjust our treatment algorithm for patients with esophageal cancer. First, I think Dr. @Goodman did an outstanding job putting ESOPEC in context in the esophageal cancer treatment landscape. In addition, ...
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Answer from: Medical Oncologist at Academic Institution
I do think we have to prioritize systemic therapy with at least 2-4 cycles of FOLFOX or FLOT (distant mets kill patients). If the consensus is that R0 resection is not achievable, then following that with CRT would be reasonable to improve locoregional control. Enrolling in induction chemo-->nCRT...
Answer from: Radiation Oncologist at Academic Institution
Dr. @Jethwa has a great X thread summarizing ESOPEC in the context of past trials with esophageal adenocarcinoma! Check it out.