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Including radiation therapy in the preoperative treatment of gastroesophageal adenocarcinoma resulted in no survival benefit over chemotherapy alone in the previously reported NEO-AEGIS (NEJM JW Oncol Hematol Oct 20 2023 and Lancet Gastroenterol Hepatol 2023; 8:1015) and TOPGEAR (NEJM JW Oncol Hematol Oct 16 2024 and N Engl J Med 2024; 391:1810) trials. Investigators now report results of the multicenter, phase 3 ESOPEC trial in which patients with esophageal or gastroesophageal junction (GEJ) adenocarcinoma were randomized to perioperative treatment with FLOT chemotherapy (fluorouracil, leucovorin, oxaliplatin, and docetaxel) or preoperative chemoradiotherapy with carboplatin, paclitaxel, and radiotherapy (41.4 Gy).
Of the 438 patients, 80%…