The CROSS trial established perioperative treatment for resectable oesophageal cancer. Carboplatin/paclitaxel plus concurrent radiotherapy (41.4 Gy in 23 fractions) given neoadjuvantly followed by oesophagectomy versus surgery alone showed:

• A No significant difference in R0 resection rate or overall survival
• B Benefit limited to squamous cell carcinoma; no benefit for adenocarcinoma
• C Significantly higher perioperative mortality in the neoadjuvant arm
• D Significant improvement in overall survival and higher pCR rate (29%) with neoadjuvant chemoradiotherapy ✓

Explanation

The CROSS trial (NEJM 2012) demonstrated that neoadjuvant chemoradiotherapy (carboplatin/paclitaxel + 41.4 Gy) followed by surgery significantly improved overall survival (median 49 vs 24 months, HR 0.657) and R0 resection rate (92% vs 69%) compared to surgery alone. The pathological complete response rate was 29% overall (49% for squamous cell carcinoma, 23% for adenocarcinoma). This is now the standard neoadjuvant approach for resectable oesophageal/GOJ cancer in most Western countries.

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

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Written and medically reviewed by the StethoPrep medical team.