Two multimodal treatment strategies, perioperative chemotherapy and preoperative chemoradiotherapy, have been shown to improve overall survival (OS) compared to surgery alone in patients with locally advanced oesophageal adenocarcinoma (EAC); however, the optimal approach has been unclear. Newly published results from the phase III ESOPEC trial demonstrate the superiority of the perioperative strategy.

In ESOPEC, 438 patients with resectable cT1–4aN+ or cT2–4aN0 EAC were randomly assigned (1:1) to receive four preoperative and four postoperative cycles of fluorouracil, leucovorin, oxaliplatin and docetaxel (FLOT) or preoperative radiotherapy (41.4 Gy in 23 fractions) plus concurrent weekly carboplatin and paclitaxel. OS was the primary end point.