Perspectives on the Current Role of Radiation in the Management of Gastroesophageal Adenocarcinomas

Over the past two decades, management approaches for esophageal and gastroesophageal junction (GEJ) cancers have undergone a notable transformation, driven by clinical trials aimed at optimizing the use of surgery, chemotherapy, and chemoradiotherapy (CRT) in treatment. Landmark studies have confirmed the essential role of neoadjuvant CRT (nCRT) and perioperative chemotherapy compared with surgery alone in improving survival rates and pathological complete response (pCR). Recently, active surveillance has emerged as a safe alternative to immediate surgery, and in select patients, adjuvant immunotherapies have demonstrated enhanced efficacy while reducing complications. This review will discuss the data that have helped shape the current treatment landscape for esophageal and GEJ cancers, as well as potential future directions.