In this podcast, Dr Angelica Petrillo, gastrointestinal (GI) oncologist at Ospedale del Mare, Naples (Italy), presents a discussion between Prof. Trevor Leong, radiation oncologist at the Peter MacCallum Cancer Centre and University of Melbourne (Australia), and Prof. Marcel Verheij, radiation oncologist at the Radboud University Medical Center, Nijmegen (The Netherlands), regarding the role of radiotherapy in non-metastatic gastroesophageal adenocarcinoma (GEA).
This is a hot topic, which has been debated extensively during the last decades, mainly while waiting for the results of some landmark trials in the field. However, important data about the use of pre- and post-operative radiotherapy have been published in the last year, potentially leading to a change in the clinical practice for non-metastatic adenocarcinomas.
In the podcast, the experts provide an overview of the topic, discussing the results of two important and recently published trials: TOPGEAR1 and ESOPEC.2 The international phase III TOPGEAR trial investigated the role of perioperative chemotherapy with or without radiotherapy (in the neoadjuvant phase) in the treatment of patients with resectable gastric adenocarcinoma and GEA.1 The trial showed no improvement in survival outcomes by adding preoperative radiotherapy to standard perioperative chemotherapy. The phase III ESOPEC trial2 randomized patients with esophageal adenocarcinoma and GEA to receive neoadjuvant chemoradiotherapy according to the CROSS schedule3 or perioperative chemotherapy according to the FLOT schedule.4 The trial showed a benefit for the perioperative chemotherapy compared with chemoradiotherapy, representing a practice-changing trial. However, in this regard, the experts have talked about differences in patients’ characteristics, toxicities and compliances, and strengths and weaknesses of the trials. In this context, the results of the Neo-AEGIS trial are also discussed.5 Additionally, the issue regarding the role of pathological response as a surrogate survival endpoint in this setting is addressed.
Finally, the experts provide some practical suggestions for upper GI oncologists and an overview of future perspectives in the field,6 in which international collaborative efforts and the multidisciplinary evaluation of patients are fundamental.
Acknowledgments
Funding
None declared.
Disclosure
AP: personal fees: Servier, Merck, Amgen, AstraZeneca, Bristol Myers Squibb (BMS), Nutricia, MSD, and Gentili; research funding: Roche, MSD; advisory board: Bayer. MV: grant support: Dutch Cancer Society. TL: personal fees: AstraZeneca.
References
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