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The trial that made chemotherapy plus radiation before surgery the standard for oesophageal cancer; the survival gain was still there ten years later.
CROSS randomised 368 patients with resectable oesophageal or gastro-oesophageal junction cancer to surgery alone or five weekly cycles of carboplatin-paclitaxel with 41.4 Gy in 23 fractions followed by surgery. Median overall survival was 49.4 months with chemoradiation versus 24.0 months with surgery alone, 29 percent had a pathological complete response, and surgical complications were not increased (van Hagen and colleagues, New England Journal of Medicine 2012). Ten-year follow-up confirmed the benefit; the CROSS regimen is a worldwide standard.
OS 49.4 vs 24.0 months (NEJM 2012); pCR 29% (49% in squamous). Ten-year OS 38% vs 25% (JCO 2021), HR for death from oesophageal cancer 0.60. The CROSS regimen is the reference arm for CheckMate 577, SANO, and most modern trials; perioperative FLOT is the alternative for adenocarcinoma (ESOPEC 2024 favoured FLOT).
Numbers are from the trial as recorded here; see the source links in the table below. This is orientation, not medical advice: ask your team how closely the trial population matches you.
366 enrolled.
| Endpoint | Arm | n | Value | HR (95% CI) | p | Source |
|---|---|---|---|---|---|---|
| Overall survivalprimary | Chemoradiation + surgery | 178 | 49.4 months | 0.68 | - | link |
| Surgery alone | 188 | 24 months | ||||
| Overall survival at 10 years | Chemoradiation + surgery | - | 38 percent | - | - | link |
| Surgery alone | - | 25 percent |
Shares CROSS chemoradiation → surgery → adjuvant nivolumab if residual disease, Organ preservation as the default after complete response in oesophageal cancer, SANO, Pathologic complete response (pCR).
Shares Chemotherapy roadmap: mustard gas → curative combinations → the warhead inside smarter drugs, Paclitaxel / nab-paclitaxel, Platinum agents, Carboplatin.
Shares Gastro-oesophageal junction (GEJ), Neoadjuvant / adjuvant / perioperative, Oesophageal cancer, Gastric & gastro-oesophageal junction cancer.
Shares Chemotherapy roadmap: mustard gas → curative combinations → the warhead inside smarter drugs, Radiotherapy roadmap: X-rays → shaped beams → fewer fractions, particles and FLASH, Paclitaxel / nab-paclitaxel, Carboplatin.
Shares Oesophageal and junctional adenocarcinoma, Paclitaxel / nab-paclitaxel, Oesophageal cancer, Carboplatin.
Shares Radiosensitisers, Chemoradiation (chemoradiotherapy, CRT), Paclitaxel / nab-paclitaxel, Carboplatin.
Shares Pathologic complete response (pCR), Neoadjuvant / adjuvant / perioperative, Paclitaxel / nab-paclitaxel, Platinum agents.
Shares Chemotherapy roadmap: mustard gas → curative combinations → the warhead inside smarter drugs, Paclitaxel / nab-paclitaxel, Platinum agents, Carboplatin.