A 62-year-old man is diagnosed with esophageal adenocarcinoma at the gastroesophageal junction (Siewert type II). Staging CT and PET show no metastasis, and endoscopic ultrasound confirms T3N1. According to current evidence, what is the preferred neoadjuvant treatment?
- A Surgery first, then adjuvant chemotherapy (FLOT protocol)
- B Perioperative chemotherapy alone with FLOT regimen
- C Neoadjuvant chemoradiotherapy (CROSS protocol — carboplatin/paclitaxel with concurrent radiotherapy) ✓
- D Definitive chemoradiotherapy without surgery
Explanation
For resectable esophageal and gastroesophageal junction carcinoma, the CROSS trial established neoadjuvant chemoradiotherapy (carboplatin + paclitaxel with 41.4 Gy concurrent radiotherapy) as a standard of care, demonstrating R0 resection in 92% and complete pathological response in 29% with improved overall survival. For distal esophageal/GEJ adenocarcinoma, perioperative FLOT chemotherapy (docetaxel, oxaliplatin, leucovorin, 5-FU) per the FLOT4-AIO trial is also acceptable and may be preferred for Siewert type III lesions. For Siewert II, both CROSS and FLOT are guideline-recommended; CROSS is widely used for esophageal/GEJ tumors.
Reference: Bailey & Love's Short Practice of Surgery, 27th ed.
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Written and medically reviewed by the StethoPrep medical team.