Results of chemoradiotherapy with CROSS regimen for middle third esophageal cancer

Background. Esophageal cancer (EC) is one of the most aggressive gastrointestinal malignancies with a poor prognosis. The standard treatment for thoracic EC involves chemoradiotherapy (CRT). For localized tumors, a multimodal approach, including neoadjuvant chemoradiotherapy followed by surgery, is considered optimal. This approach can improve long-term treatment outcomes and provide better local control. The CROSS regimen is a commonly used chemoradiotherapy regimen for EC in Europe and Russia.

Objective: to evaluate the effectiveness of chemoradiotherapy with the CROSS regimen administered both preoperatively and alone, as well as to assess long-term overall and recurrence-free survival rates.

Material and Methods. This retrospective study included patients with stage I–III thoracic esophageal cancer treated at the Ulyanovsk Regional Clinical Oncology Center from January 1, 2019, to December 31, 2023. A total of 94 patients began chemoradiotherapy in the CROSS regimen. The final analysis included 80 (85.1 %) patients who completed the entire treatment program. Data collection was performed according to a unified protocol.

Results. The rate of complete pathological response (TRG 1) was 10/26 (38.5 %). The 1-year overall survival rates in patients undergoing surgery and in patients not undergoing surgery were 83.3 % and 71.7 %, respectively. The 3-year overall survival rates in patients undergoing surgery and in patients not undergoing surgery were 58.3 % and 50.9 %, respectively. The 1-year and 3-year recurrence-free survival rates were higher in patients who received CRT followed by surgery compared to those who received CRT alone (76.9 % versus 63.5 % and 53.9 % versus 44.2 %).

Conclusion. Chemoradiotherapy with the CROSS regimen was shown to achieve a complete response in more than a third of EC patients. Survival rates were higher in patients undergoing a three-modality approach.

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