Ten-Year Outcome of Neoadjuvant Chemoradiotherapy Plus Surgery for Esophageal Cancer: The Randomized Controlled CROSS Trial
- Study type
- Clinical trial
- Study name
- CROSS
- Design
- Randomised controlled trial; long-term follow-up report (to 2018)
- Sample size
- 366 patients
- Source
- JCO · 2021
In plain words
In this study, patients with oesophageal cancer that could still be removed by surgery either had chemoradiotherapy before the operation followed by surgery, or had surgery alone. After about 12 years of follow-up, the results showed that those who had chemoradiotherapy before surgery lived longer: 38% were alive after 10 years, compared with 25% in the surgery-alone group. This treatment mainly prevented the disease from coming back in the oesophagus itself and the area around it.
Key results
Treatment arms and regimens
Weekly carboplatin dosed to AUC 2 mg/mL per minute and weekly paclitaxel 50 mg/m² IV, for 5 weeks, concurrently with radiotherapy 41.4 Gy in 23 fractions (5 days a week); followed by oesophagectomy.
Surgery without neoadjuvant treatment.
Source of the regimen details: Abstract of this paper (radiotherapy schedule and dose) and abstract of the primary CROSS trial report (van Hagen et al., NEJM 2012; carboplatin and paclitaxel doses)
Doses are given for the information of specialists, as in this study’s protocol, and are not a prescription. Every drug must be prescribed by the treating physician for the individual patient.
Study population
Patients with locally advanced, resectable cancer of the oesophagus or gastro-oesophageal junction. These patients were enrolled between 2004 and 2008. Other inclusion criteria are not given in the abstract.
Endpoints
Overall survival, disease-specific survival, and the risk of locoregional and distant recurrence were compared with Cox regression. The effect of neoadjuvant treatment beyond 5 years of follow-up was assessed with time-dependent Cox regression and landmark analyses.
Safety and side effects
The abstract of this long-term report gives no data on grade ≥3 adverse events. The only related finding is that death from other causes (other than oesophageal cancer) was similar between the two groups (hazard ratio 1.17; 95% CI 0.68–1.99).
Clinical significance and place in guidelines
These ten-year results show that the survival advantage of the CROSS preoperative chemoradiotherapy regimen in patients with locally advanced, resectable cancer of the oesophagus or gastro-oesophageal junction persists for at least 10 years, reinforcing this regimen as standard treatment. Its exact status in current clinical guidelines should be checked separately.
Limitations
The abstract gives no information on adverse events, quality of life or histological subgroups. Isolated distant recurrence showed no significant difference between the two groups. For details of methodology and limitations, the full text of the paper should be consulted.
This summary was prepared by the editorial team from the published paper; the original paper is the final reference. Read the original abstract on PubMed.