FLOT vs. CROSS for Gastroesophageal Junction Cancers Comparison

Core Concepts

Multimodality approaches like FLOT and CROSS trials show similar outcomes for GEJ cancers.

Abstract

Abstract Incidence of GEJ adenocarcinomas rising due to obesity and GERD. Multimodality approach improves outcomes for locally advanced GECs. Debate on 'gold standard' treatment for GEJ cancers. FLOT and CROSS trials show similar improvements in OS and DFS. Introduction GECs rank 2nd highest in global cancer mortality. GECs subclassified into esophageal, GEJ, and gastric tumors. Histologic subtypes dictate treatment options. Risk factors include smoking, alcohol use, GERD, Barrett's esophagus. Staging crucial for treatment decisions and prognosis. Siewert classification guides treatment and surgical techniques. Neoadjuvant or perioperative chemotherapy superior to surgery alone. Tri-modality treatment improves R0 resection rates and OS. Perioperative FLOT regimen now standard for GEJ cancer treatment.

Stats

In the last two decades, the incidence of gastroesophageal junction (GEJ) adenocarcinomas (AC) has increased. Neoadjuvant therapy with chemotherapy and radiation (RT) followed by surgery is now considered standard practice for most esophageal cancers. Peri-operative chemotherapy with epirubicin-based triplet chemotherapy showed improvement in OS for patients with locally advanced gastric cancer. The new standard of care for gastric cancer has become another triplet chemotherapy regimen with fluorouracil, leucovorin, oxaliplatin, docetaxel (FLOT).

Quotes

"GECs rank 2nd highest in global cancer mortality." "Tri-modality treatment has significantly improved R0 resection rates and overall survival (OS)."

Key Insights Distilled From

FLOT or CROSS for Gastroesophageal Junction Cancers

by Bushra Shari... at www.medscape.com 10-18-2023

http://www.medscape.com/viewarticle/994561

Deeper Inquiries

What are the implications of the rising incidence of GEJ adenocarcinomas due to obesity and GERD

The rising incidence of gastroesophageal junction (GEJ) adenocarcinomas due to obesity and gastroesophageal reflux disease (GERD) has significant implications on healthcare systems and patient outcomes. Obesity is a well-established risk factor for various cancers, including GEJ adenocarcinomas. Excess body weight can lead to chronic inflammation, insulin resistance, and altered hormone levels, all of which can promote cancer development. Additionally, untreated GERD, which is often associated with obesity, can lead to Barrett's esophagus, a precursor to esophageal adenocarcinoma. The combination of these factors has contributed to the increasing incidence of GEJ adenocarcinomas over the past two decades. The implications of this rising incidence are multifaceted. From a public health perspective, healthcare systems need to be prepared to diagnose and treat a growing number of GEJ adenocarcinoma cases. This requires increased resources for screening, early detection, and treatment. Furthermore, the aggressive nature of GEJ adenocarcinomas means that a significant number of patients will require complex and costly treatments, impacting healthcare budgets and resources. From a patient perspective, the rising incidence means that more individuals are at risk of developing this aggressive form of cancer, highlighting the importance of preventive measures, early detection, and access to high-quality care.

How do the FLOT and CROSS trials impact the current standard of therapy for GEJ cancer

The FLOT and CROSS trials have had a significant impact on the current standard of therapy for gastroesophageal junction (GEJ) cancer. Both trials have demonstrated the efficacy of multimodal approaches in improving overall survival (OS) and disease-free survival (DFS) for patients with resectable locoregional GEJ cancers. The FLOT trial, which evaluated the use of fluorouracil, leucovorin, oxaliplatin, and docetaxel in the perioperative setting, showed promising results in terms of improved outcomes compared to previous chemotherapy regimens. On the other hand, the CROSS trial focused on neoadjuvant chemoradiation followed by surgery and also showed significant improvements in OS and DFS for patients with GEJ cancer. As a result of these trials, both neoadjuvant chemoradiation (CRT) and perioperative FLOT chemotherapy have become standard treatment options for locally advanced GEJ cancer. The choice between these two approaches may depend on various factors such as patient characteristics, tumor stage, and institutional preferences. The findings from the FLOT and CROSS trials have provided clinicians with valuable evidence to guide treatment decisions and improve outcomes for patients with GEJ cancer.

How can the Siewert classification guide treatment decisions for GEJ cancers

The Siewert classification plays a crucial role in guiding treatment decisions for gastroesophageal junction (GEJ) cancers. This classification system categorizes GEJ tumors based on their epicenter relative to the gastroesophageal junction, helping to determine the most appropriate treatment approach. Siewert class I includes tumors with the epicenter 1 to 5 cm above the GEJ, class II includes tumors with the epicenter 1 cm proximal to GEJ to 2 cm distal to GEJ, and class III includes tumors with the epicenter within 2 to 5 cm distal to the GEJ. By using the Siewert classification, clinicians can tailor treatment strategies to the specific location of the tumor. For example, tumors classified as Siewert class I may be more amenable to surgical resection, while those classified as Siewert class II or III may benefit from neoadjuvant chemoradiation or perioperative chemotherapy. Additionally, the Siewert classification can help guide surgical techniques and determine the extent of resection needed to achieve optimal outcomes for patients with GEJ cancer. Overall, incorporating the Siewert classification into treatment decision-making ensures a more personalized and effective approach to managing GEJ cancers.