Background/Objectives: Neoadjuvant radiochemotherapy and perioperative chemotherapy are both well-established treatment strategies for locally advanced adenocarcinoma of the esophagus (EAC) and the esophagogastric junction (AEGJ). However, recent knowledge controversially discusses whether neoadjuvant radiotherapy or perioperative chemotherapy represents superior therapeutic options to prolong survival or cause less toxicity. Methods: We retrospectively analyzed 76 patients with locally advanced EAC or AEGJ treated at our tertiary cancer center between January 2015 and March 2023. Patients received either perioperative FLOT chemotherapy (n = 36) or neoadjuvant radiochemotherapy following the CROSS protocol (n = 40), followed by surgical resection and standardized follow-up. We compared survival outcomes, toxicity profiles, treatment compliance, and surgical results between the two groups. Results: There were no statistically significant differences between FLOT and CROSS treatments in five-year loco-regional controls (LRC: 61.5% vs. 68.6%;p= 0.81), progression-free survival (PFS: 33.9% vs. 42.8%;p= 0.82), overall survival (OS: 60.2% vs. 63.4%;p= 0.91), or distant controls (DC: 42.1% vs. 56.5%;p= 0.39). High-grade hematologic toxicities did not significantly differ between groups (p> 0.05). Treatment compliance was lower in the FLOT group, with 50% (18/36) not completing all the planned chemotherapy cycles, compared to 17.5% (7/40) in the CROSS group. All the patients in the CROSS group received the full radiotherapy dose. Surgical outcomes and post-surgical tumor status were comparable between the groups. Conclusions: Although perioperative chemotherapy with FLOT has recently become a standard of care for locally advanced EAC and AEGJ, neoadjuvant radiochemotherapy per the CROSS protocol remains a well-tolerated alternative. In appropriately selected patients, both approaches yield comparable oncological outcomes.
背景/目的：新辅助放化疗与围手术期化疗均是治疗局部晚期食管腺癌（EAC）及食管胃结合部腺癌（AEGJ）的成熟策略。然而，近期研究对新辅助放疗与围手术期化疗在延长生存期或降低毒性方面孰优孰劣存在争议。方法：我们回顾性分析了2015年1月至2023年3月期间在本三级癌症中心接受治疗的76例局部晚期EAC或AEGJ患者。患者分别接受围手术期FLOT化疗（n=36）或遵循CROSS方案的新辅助放化疗（n=40），随后均进行手术切除及标准化随访。我们比较了两组患者的生存结局、毒性特征、治疗依从性及手术结果。结果：FLOT与CROSS治疗在五年局部区域控制率（LRC：61.5% vs. 68.6%；p=0.81）、无进展生存期（PFS：33.9% vs. 42.8%；p=0.82）、总生存期（OS：60.2% vs. 63.4%；p=0.91）及远处控制率（DC：42.1% vs. 56.5%；p=0.39）方面均无统计学显著差异。两组间高级别血液学毒性发生率无显著差异（p>0.05）。FLOT组治疗依从性较低，50%（18/36）患者未完成所有计划化疗周期，而CROSS组该比例为17.5%（7/40）。CROSS组所有患者均接受了全剂量放疗。两组手术结果及术后肿瘤状态具有可比性。结论：尽管围手术期FLOT化疗近年来已成为局部晚期EAC和AEGJ的标准治疗方案，但遵循CROSS方案的新辅助放化疗仍是耐受性良好的替代选择。对于经恰当筛选的患者，两种方案可获得相当的肿瘤学结局。
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