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Upper GI: Oesophageal neoadjuvant chemoRT vs perioperative chemo - histology

Free question published 30 September 2026

Upper GIOesophageal neoadjuvant chemoRT vs perioperative chemo - histology

An upper GI MDT is planning curative treatment for two fit patients with WHO performance status 0. Patient 1 has a cT3N1M0 squamous cell carcinoma of the mid-oesophagus; patient 2 has a cT3N1M0 adenocarcinoma of the gastric body. A trainee asks how the standard multimodality approach differs by histology and site. Which statement is most accurate?

  1. AThe gastric adenocarcinoma should receive radical chemoradiotherapy and the squamous tumour perioperative chemotherapy
  2. BBoth should receive perioperative FLOT chemotherapy and surgery
  3. CThe squamous mid-oesophageal tumour should receive radical or neoadjuvant chemoradiotherapy and the gastric adenocarcinoma perioperative chemotherapy and surgery
  4. DBoth should receive neoadjuvant carboplatin-paclitaxel chemoradiotherapy and surgery
  5. EBoth should receive definitive chemoradiotherapy without surgery

Why C is correct

Mid-oesophageal squamous cell carcinoma is highly radiosensitive: NICE NG83 offers resectable non-metastatic oesophageal squamous cell carcinoma the choice of radical chemoradiotherapy or chemoradiotherapy before surgery, and CROSS demonstrated a particularly marked effect in squamous histology (pathological complete response 49%). Gastric adenocarcinoma, by contrast, is treated with perioperative chemotherapy before and after surgery (NG83 1.4.9), with FLOT the preferred regimen for fit patients.

And why the others are not

  • AThis reverses the correct pairing; radical chemoradiotherapy is the radiosensitive squamous oesophageal option, not a gastric adenocarcinoma strategy.
  • BFLOT is a gastro-oesophageal adenocarcinoma regimen; it is not the standard approach for oesophageal squamous cell carcinoma, which is radiosensitive and managed with chemoradiotherapy.
  • DNeoadjuvant carboplatin-paclitaxel chemoradiotherapy (CROSS) applies to oesophageal and junctional tumours, not to a gastric body adenocarcinoma, which is treated with perioperative chemotherapy.
  • EDefinitive chemoradiotherapy without surgery is not the standard approach for either a fit gastric adenocarcinoma patient or as the sole option for resectable squamous disease where surgery remains a choice.

Source NICE NG83 - Oesophago-gastric cancer: assessment and management in adults — National Institute for Health and Care Excellence. Oesophago-gastric cancer: assessment and management in adults. NICE guideline NG83. Published 24 January 2018.

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