10-year Outcome of a Randomized Trial Comparing Neoadjuvant Chemoradiotherapy and Surgery with Surgery Alone for Esophageal Cancer (CROSS trial)

CROSS Study Grp, Ben M. Eyck, J. Jan B. van Lanschot, Maarten C. C. M. Hulshof, Berend J. van der Wilk, Joel Shapiro, Pieter van Hagen, Mark I. van Berge Henegouwen, Bas P. L. Wijnhoven, Hanneke W. M. van Laarhoven, Grard A. P. Nieuwenhuijzen, Geke A. P. Hospers, Johannes J. Bonenkamp, Miguel A. Cuesta, Reinoud J. B. Blaisse, Olivier R. Busch, Geert-Jan M. Creemers, Cornelis J. A. Punt, John Th. M. Plukker, Henk M. W. VerheulErnst J. Spillenaar Bilgen, Maurice J. C. van der Sangen, Tom Rozema, Fiebo J. W. ten Kate, Jannet C. Beukema, Anna H. M. Piet, Caroline M. van Rij, Janny G. Reinders, Hugo W. Tilanus, Ewout W. Steyerberg, Ate van der Gaast



Background: Neoadjuvant chemoradiotherapy according to the Chemo-
Radiotherapy for Oesophageal cancer followed by Surgery Study (CROSS)
has become a standard of care for patients with locally advanced resectable
esophageal or junctional cancer. However, the long-term benefits and
harms remain unclear.We aimed to assess the long-term outcomes of this
Materials and Methods: From 2004 through 2008, 366 patients were
randomly assigned to either five weekly cycles of intravenous carboplatin
(area under the curve of 2 mg/mL/min) and paclitaxel (50 mg/m2 bodysurface
area) on days 1, 8,15, 22, and 29 with concurrent radiotherapy (41.4
Gy in 23 fractions, 5 days per week) followed by surgery, or surgery alone.
Follow-up data were collected through 2018. Overall survival was estimated
with the Kaplan-Meier method and compared with Cox regression
analyses. The effect beyond 5 years of follow-up was assessed by using
landmark analyses. Also, cause-specific mortality was estimated with cumulative
incidence functions and compared with Cox regression.
Results: The median follow-up was 147 months (IQR 134-157). Patients
who received neoadjuvant chemoradiotherapy had better overall survival
(HR 0.70, 95%CI 0.55-0.89), with 10-year overall survival of 38% (95%CI 31-
45) in the neoadjuvant chemoradiotherapy plus surgery arm and 25% (95%
CI 19-32) in the surgery alone arm. Landmark analyses showed that the
overall survival benefit that was gained in the first 5 years, persisted
beyond 5 years. The risk of death from esophageal cancer was lower for
patients who received neoadjuvant chemoradiotherapy plus surgery (HR
0.60, 95% CI 0.46-0.80), while death from other causes was comparable
between both study arms (HR 1.17, 95%CI 0.68-1.99).
Conclusions: The overall survival benefit of patients with locally advanced
resectable esophageal or esophagogastric junctional cancer who received
neoadjuvant chemoradiotherapy plus surgery according to the CROSS
regimen persists for at least 10 years, compared with surgery alone.
Originele taal-2English
Pagina's (van-tot)S147-S147
Aantal pagina's1
TijdschriftAnnals of Surgical Oncology
Nummer van het tijdschriftSUPPL 1
StatusPublished - feb.-2021

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