Präoperative Radiochemo- versus Chemotherapie des ösophagogastralen Übergangs

High rates of locoregional and systemic recurrence limit the prognosis of patients with resectable locally advanced gastroesophageal junction adenocarcinomas and make perioperative treatment strategies necessary. Derived from patient cohorts with esophageal cancers of predominantly squamous cell tumor histology, neoadjuvant radiochemotherapy according to the CROSS regimen has commonly been conducted. At the same time, perioperative chemotherapy in patients with advanced gastric and junctional tumors has evolved and demonstrated clinical efficacy, especially in the FLOT trial. Results from the recent ESOPEC study have clearly shown that perioperative chemotherapy is superior to neoadjuvant radiochemotherapy and support its use as the primary standard of care. A combination of radiotherapy with the potent and effective chemotherapy regimen of the FLOT trial and the additional integration of checkpoint inhibitors are currently under clinical investigation. In the case of ineligibility for FLOT-based perioperative chemotherapy, neoadjuvant radiochemotherapy followed by nivolumab may be offered to patients with locally advanced junctional adenocarcinomas.