A 55-year-old man presents with progressive dysphagia and weight loss. OGD reveals a malignant-looking stricture in the lower oesophagus. Biopsy confirms adenocarcinoma. PET-CT staging shows no distant metastases, and staging laparoscopy is negative. EUS shows T3N1. According to the FLOT protocol (FLOT4-AIO trial), the perioperative chemotherapy regimen is:

• A 3 pre-operative and 3 post-operative cycles of ECF (epirubicin + cisplatin + 5-FU)
• B 6 cycles of FOLFOX post-operatively only
• C Chemoradiotherapy (cisplatin + 5-FU + 45 Gy) followed by surgery
• D 4 pre-operative and 4 post-operative cycles of FLOT (docetaxel + oxaliplatin + leucovorin + 5-FU) ✓

Explanation

The FLOT4-AIO trial (Al-Batran et al., 2019) established FLOT (docetaxel, oxaliplatin, leucovorin, 5-FU; 2-weekly cycles) as the new standard of care for resectable gastric and gastro-oesophageal junction (GOJ) adenocarcinoma. The regimen is 4 pre-operative + 4 post-operative cycles, showing superior overall survival compared to 3+3 cycles of ECF. ECF (the MAGIC trial regimen) is now considered the older standard. Concurrent chemoradiotherapy (CROSS protocol) is the standard for oesophageal SCC and GOJ tumours approaching as oesophageal cancers in some centres.

Reference: Bailey & Love's Short Practice of Surgery, 27th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.