A 65-year-old man with dysphagia is found to have a T3 N1 M0 squamous cell carcinoma of the mid-thoracic oesophagus. He is fit for surgery (ECOG PS 1). According to current ESMO/NICE guidelines, the optimal treatment is:

• A Neoadjuvant chemoradiotherapy (CROSS protocol: carboplatin/paclitaxel + 41.4 Gy) followed by oesophagectomy ✓
• B Upfront oesophagectomy (Ivor Lewis) without neoadjuvant therapy
• C Definitive chemoradiotherapy (50.4 Gy + concurrent cisplatin/5-FU) without surgery
• D Neoadjuvant chemotherapy (ECF) followed by oesophagectomy

Explanation

The CROSS trial established neoadjuvant chemoradiotherapy (carboplatin AUC2 + paclitaxel 50 mg/m² weekly for 5 weeks with concurrent 41.4 Gy radiotherapy) followed by oesophagectomy as the standard treatment for locally advanced, resectable oesophageal and junctional carcinoma. This protocol significantly improved R0 resection rates, pathological complete response, and overall survival compared to surgery alone.

Reference: Bailey & Love's Short Practice of Surgery, 27th ed.

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Written and medically reviewed by the StethoPrep medical team.