Applying DFLOT to a Real World Case of Resectable Stage III GE Junction Cancer

This segment introduces the first case discussion. The panel examines perioperative goals for a PD-L1–positive, surgically fit patient and outlines how DFLOT may fit into this clinical scenario. The discussion emphasizes the need to control micrometastatic disease early, optimize the chance of a meaningful response before surgery, and avoid non-therapeutic operations in patients who demonstrate aggressive biology. The panel also stresses the importance of careful patient selection, recognizing that some individuals may be marginal surgical candidates and may require alternative approaches, such as chemoradiation, if the likelihood of reaching surgery is uncertain. Additional themes include the importance of prehabilitation, nutrition support, and early multidisciplinary coordination to maintain fitness through neoadjuvant therapy. The surgeons highlight the role of staging laparoscopy to confirm local disease and note that comprehensive support systems can improve tolerability and completion of perioperative therapy.