Dr. Sun Discusses the Debate Between Radiation and Chemotherapy in GEJ Cancers

Weijing Sun, MD, gastrointestinal oncologist at the University of Kansas School of Medicine, discusses the debate between the use of radiation and chemotherapy in patients with locally advanced gastroesophageal junction (GEJ) adenocarcinoma.

There are 2 preoperative therapeutic approaches for patients with locally advanced GEJ cancer, explains Sun—one includes radiation therapy and one does not. In the FLOT study, investigators explored a regimen comprised of fluorouracil, leucovorin, oxaliplatin, and docetaxel without radiation. In the CROSS study, investigators looked at the combination of carboplatin and paclitaxel with radiation. Although both are suitable options for patients, explains Sun, their respective roles are controversial.

Radiation is a local treatment as opposed to chemotherapy, which is a systemic therapy. They are both effective ways to shrink a tumor prior to resection, says Sun, but in terms of managing micrometastatic disease, radiation is not considered to be as effective as chemotherapy, as it is a local treatment. There are 2 parameters by which treatment effectiveness is assessed, says Sun. One is response rate, while the other is disease-free survival after surgery. In terms of response rate, both modalities demonstrate similar efficacy, but in terms of disease-free survival, the roles of radiation and chemotherapy are less clear, explains Sun.