Pathologic tumor response to neoadjuvant chemotherapy in gastroesophageal cancer: what does it mean?

Surgical resection of the primary tumor and regional lymph nodes is the most effective method to cure resectable gastroesophageal cancer; however, the cancer often recurs even after curative resection. Therefore, multimodal therapeutic protocols, such as perioperative chemotherapy or chemoradiotherapy, are increasingly employed to improve the treatment outcomes. Since the Medical Research Council Adjuvant Gastric Infusional Chemotherapy (MAGIC) trial demonstrated the survival benefits for patients with preoperative and postoperative chemotherapy with epirubicin, cisplatin and infused fluorouracil (ECF) when compared with surgery alone (1), perioperative chemotherapy is the recommended standard of care for resectable gastroesophageal cancer especially in Europe. However, despite the improvement of 13 percentage points in survival rate compared with surgery alone, 5-year overall survival (OS) rates for patients in the perioperative chemotherapy arm in the MAGIC trial remained at 36.3%.