Abstract Background The prognosis after surgery for oesophagogastric cancer remains poor. Methods This review clarifies current indications for neoadjuvant therapy for oesophageal and gastric cancer. A systematic literature research and evaluation of data from international cancer meetings were carried out. Results Recently published results of large randomized phase III trials underscore the potential value of neoadjuvant treatment for oesophagogastric cancer. However, it remains uncertain which subgroups of patients should routinely undergo preoperative therapy. Metabolic response evaluation during neoadjuvant treatment is a promising tool for the selection of responding patients. Conclusion Neoadjuvant chemotherapy is a valid option for locally advanced oesophageal and gastric cancer. In the future, more effective and better tolerated treatment strategies, tailored to the specific tumour characteristics of each individual, should be possible.