The CROSS trial established the role of neoadjuvant treatment for resectable esophageal and gastroesophageal junction (GEJ) cancer. Which treatment regimen was used, and what were its key benefits?
- A Perioperative FLOT chemotherapy (docetaxel, oxaliplatin, leucovorin, 5-FU); improved R0 resection rate and overall survival
- B Neoadjuvant carboplatin/paclitaxel + 41.4 Gy concurrent radiotherapy; improved complete resection (R0) rate and 5-year overall survival compared to surgery alone ✓
- C Adjuvant chemoradiotherapy with capecitabine + oxaliplatin after surgery
- D Pre-operative cisplatin + 5-FU with 50 Gy radiotherapy; no survival benefit but improved dysphagia
Explanation
The CROSS trial (van Hagen et al., NEJM 2012) randomized 368 patients with resectable esophageal/GEJ cancer (predominantly adenocarcinoma and squamous cell) to neoadjuvant carboplatin/paclitaxel with 41.4 Gy concurrent radiation followed by surgery versus surgery alone. Neoadjuvant chemoradiotherapy achieved: 92% R0 resection rate (vs 69% surgery alone), 29% pathological complete response in adenocarcinoma (49% in squamous cell), and median overall survival of 49.4 months (vs 24.0 months). The 5-year overall survival was 47% vs 34%. CROSS established neoadjuvant chemoradiotherapy as a standard for esophageal cancer. FLOT (docetaxel, oxaliplatin, leucovorin, 5-FU) perioperative chemotherapy applies specifically to gastric/GEJ adenocarcinoma (FLOT4-AIO trial).
Reference: Bailey & Love's Short Practice of Surgery, 27th ed.
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