Induction Chemotherapy vs Chemoradiotherapy for Esophageal Adenocarcinoma

Locally advanced esophageal adenocarcinoma warrants multimodal therapy incorporating neoadjuvant therapy followed by an en bloc transthoracic resection. Whilst the debate regarding the efficacy of neoadjuvant chemoradiotherapy versus chemotherapy continues, much of the previous evidence concerning the benefit of chemoradiotherapy is derived from patients with squamous cell carcinoma. Conversely, more recent data suggests these modalities may be at least equivalent in treating patients with adenocarcinoma. However, with the advent of modern chemotherapeutic regimens, and more recently immunotherapy, we suggest that neoadjuvant systemic therapy is more efficacious in treating esophageal adenocarcinoma. Although more data is needed to formally make this conclusion, future advances will likely highlight the importance of personalizing patient treatment to maximize survival outcomes in this challenging cancer.