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The management of localised oesophageal and gastro-oesophageal (GO J) cancer has significantly evolved over last few years.Neo-adjuvant therapy is commonly employed to downstage the primary tumour and facilitates complete surgical resection (R0) combined with the targeting of occult micro-metastatic disease.Pre-operative chemoradiotherapy (CRT) is more frequently employed in the US compared to the UK practice of neo-adjuvant chemotherapy.Despite several previous studies and meta-analysis the optimum neo-adjuvant therapy remains unclear.Most of the above studies have compared individual options with surgery alone.Rather surprisingly, there are hardly any trials that have compared one modality against the other (e.g.neo-adjuvant chemotherapy versus CRT).There are at least 17 published randomized studies of neo-adjuvant CRT (n =9) and chemotherapy (n =8) compared with surgery alone and one prospective series that compared the above modalities against each other.Studies evaluating CRT have reported pathological complete response rates of 15-40% and no increase in postoperative mortality was observed, except in one study that used a hypofractionated radiation schedule.Two randomized studies showed significant overall survival (OS) benefit and the remaining (n =7) were negative, but showed a trend towards improved survival.Most of these studies suffered from small sample size which probably negated the OS benefit.This was highlighted by at least four various meta-analyses showing significant improvement in survival after CRT extending up to an absolute benefit of 13% at 2 years.In comparison, five studies ofneo-adjuvant chemotherapy showed no survival difference and two of the remaining studies that showed significant benefit included gastric adenocarcinomas and employed peri-operative chemotherapy.All the above studies have shown uniformly poor pathological complete response rates of less than 10 percent.Moreover, three meta-analyses were negative, but two showed up to 7% absolute survival benefit at 2 years in favor of chemotherapy.The trial comparing the above modalities showed a trend towards improved survival in favor of CRT, but closed early due to poor recruitment.In summary, the data from the above studies are potentially conflicting and inconclusive for defining the optimum neo-adjuvant treatment schedule.In our opinion, the above question can only be answered within the context of a well-designed large randomized control trial.