Multimodal primary treatment of localised adenocarcinoma of the stomach, the oesophagus and the oesophagogastric junction (AEG) was reviewed by a multidisciplinary expert panel in a moderated consensus session. Here, we report the key points of the discussion and the resulting recommendations. The exact definition of the tumour location and extent by white light endoscopy in conjunction with computed tomography scans is the backbone for any treatment decision. Their value is limited with respect to the infiltration depth, lymph node involvement and peritoneal involvement. Additional endoscopic ultrasound was recommended mainly for tumours of the lower oesophagogastric junction (i.e. AEG type II and III according to Siewert) and in early cancers before endoscopic resection. Laparoscopy to diagnose peritoneal involvement was thought to be necessary before the start of neoadjuvant treatment in all gastric cancers and in AEG type II and III. In general, perioperative multimodal treatment was suggested for all locally advanced oesophageal tumours and for gastric cancers with a clinical stage above T1N0. There was consensus that the combination of fluorouracil, folinic acid, oxaliplatin and docetaxel is now a new standard chemotherapy (CTx) regimen for fit patients. In contrast, the optimal choice of perioperative CTx versus neoadjuvant radiochemotherapy (neoRCTx), especially for AEG, was identified as an open question. Expert treatment recommendations depend on the tumour location, biology, the risk of incomplete (R1) resection, response to treatment, local or systemic recurrence risks, the predicted perioperative morbidity and patients' comorbidities. In summary, any treatment decision requires an interdisciplinary discussion in a comprehensive multidisciplinary setting.

Cambridge University Hospitals NHS Foundation Trust Cambridge United Kingdom

CaritasKlinikum St Theresia Saarbrücken Germany

Centre for Visceral Thoracic and Specialized Tumor Surgery Klinik Hirslanden Zurich Switzerland

Département d'Oncologie Médicale Institut du Cancer de Montpellier Montpellier France

Department of Comprehensive Cancer Care Masaryk Memorial Cancer Institute Brno Czech Republic

Department of Diagnostic Radiology The Royal Marsden London United Kingdom

Department of Epidemiology and Preventive Medicine School of Public Health Monash University The Alfred Centre Melbourne Australia

Department of Medicine Surgery and Neurosciences University of Siena Siena Italy

Department of Oncology Lausanne University Hospital Lausanne Switzerland

Department of Pathology and GROW School for Oncology and Developmental Biology Maastricht University Medical Centre Maastricht The Netherlands; Division of Pathology and Data Analytics Leeds Institute of Medical Research at St James's School of Medicine University of Leeds Leeds UK

Department of Pathology Christian Albrechts University Kiel Germany

Department of Pathology Faculdade de Medicina Universidade do Porto Porto Portugal

Department of Radiation Oncology Netherlands Cancer Institute Amsterdam The Netherlands

Gastroenterology Centre Klinik Hirslanden Zurich Switzerland

Hôpitaux Universitaires de Genève Service de Chirurgie Viscéral Geneva Switzerland

Institut für Pathologie Universitätsklinikum Carl Gustav Carus Dresden Germany

Institut Gustave Roussy Villejuif France

Medizinische Klinik und Poliklinik Universitätsmedizin Mainz Mainz Germany

Royal Marsden NHS Foundation Trust London United Kingdom; Cambridge University Hospitals NHS Foundation Trust Cambridge United Kingdom

Tumor und Brustzentrum ZeTuP St Gallen Switzerland

Université de Lille Department of Digestive and Oncological Surgery Claude Huriez University Hospital 59000 Lille France

Université René Descartes UFR Biomédicale des Saints Pères Paris France

University Cancer Center Leipzig and Department of Hematology and Oncology University Medicine Leipzig Germany

University Hospital Gasthuisberg Leuven Belgium

References provided by Crossref.org