Chemotherapy with or without Radiation or Surgery in Treating Participants with Oligometastatic Esophageal or Gastric Cancer

Inclusion Criteria

• The patient has a pathologic diagnosis of tumor biopsy or fine needle aspiration (FNA) of esophageal or gastric cancer of any histology including adenocarcinoma, squamous, or signet ring and others
• The patient is staged with esophago-gastro-duodenoscopy (EGD) and PET/CT scan
• The patient has three or less observable metastatic lesions. Patients may have three or less radiographically visible metastatic lesions at diagnosis or if have regressed to three or less metastatic lesions after induction chemotherapy at time of randomization. The patient must have pathologic confirmation and or radiologically visible disease. For esophageal tumors, the maximal dimension of the primary tumor may not provide reproducible measurements for RECIST and may not be visible on CT or PET/CT at diagnosis or after induction chemotherapy. Accordingly, patients are eligible regardless of the imaging measurements of the primary tumor. Additionally, in patients with non-measurable metastases, patients are eligible if there is pathology confirming metastases from a distant site. However, biopsy of a metastatic site is not required if there are visible metastases on imaging (such as ultrasound, diagnostic CT , EUS, PET/CT). We recommend patients’ medical records reviewed and discussed at multidisciplinary tumor board for eligibility
• The patient has three or less observable metastatic lesions by diagnostic scans (CT scan, PET/CT, eEndoscopic ultrasound, MRI, or bone scan). Metastatic lesions include distant M1 lymph node group; which will be counted as one site (M1 metastatic lymph nodes to include cervical, mediastinal, gastric, retroperitoneal lymph nodes will be counted as one lesion). Osseous metastases or visceral metastases will each count as one metastatic site. Each central nervous system (CNS) metastases will count as one metastatic site. Satellite lesions in the primary esophageal malignancy such as skipped esophageal primaries are not considered metastatic sites. Symptomatic metastatic sites can be treated locally prior to randomization or by palliative radiation. Symptomatic metastatic sites may be treated with radiation or surgery prior to enrollment
• Patient Eastern Cooperative Oncology Group (ECOG) of 0-2, with life expectancy of at least 6 months
• Patients age >= 18 years old but =< 80 years old and signed informed consent
• Women of child bearing age must have pregnancy test at time of enrollment, agree to use of adequate contraception (birth control hormone or barrier method) for the duration of the study and for six months after discontinuation of systemic agents

Exclusion Criteria

• Patients with prior definitive chemotherapy and radiation therapy at their primary site of esophageal or gastric cancer. Patients with prior radiation therapy to same site for another diagnosis of cancer. Note: Patients may receive palliative radiation to their symptomatic sites of metastases but not definitive local therapy to esophageal or gastric primary prior to randomization. All patients may be enrolled on protocol at start of systemic therapy; if they do not have evidence of disease progression at re-staging following initial therapy, they may be randomized. Patients are eligible if they receive prior systemic therapy (chemotherapy, immunotherapy, targeted therapy or other systemic therapy) up to 6-8 cycles as long as total does not exceed 8 cycles before randomization
• Patients with fistula documented radiographically or by EGD/EUS, endobronchial ultrasound (EBUS)
• Patients with life expectancy less than 6 months, ECOG > 3
• Female patients who are pregnant confirmed by beta human chorionic gonadotropin (bHCG) laboratory (lab) test
• Patient has history of uncontrolled angina, congestive heart failure or recent myocardial infarction (MI) within 6 months
• Nursing females
• Patients in poor nutritional state
• Patients with: * Severely depressed bone marrow function * Potentially serious infections * Known hypersensitivity to 5-fluorouracil * Known or suspected to have a dihydropyrimidine dehydrogenase deficiency (as these patients are at a greater risk of experiencing symptoms of toxicity)