Esophageal Cancer · Radiation Oncology
CROSS
In resectable locally advanced esophageal or GEJ cancer, does neoadjuvant chemoradiotherapy followed by surgery improve survival over surgery alone?
Population
368 patients with resectable esophageal or gastroesophageal-junction cancer
Treatment
Weekly carboplatin/paclitaxel with radiotherapy followed by surgery
5-year OS
47% vs 34%
Absolute improvement 13 points; NNT 8
R0 resection
92% vs 69%
Absolute improvement 23 points
Absolute Effect
NNT: 8, based on 5-year overall survival. The absolute survival gain was 13 percentage points at five years.
NNH: not quantifiable. No single fixed-time severe-toxicity endpoint provides a defensible trial-level NNH.
Clinical interpretation
CROSS established neoadjuvant chemoradiotherapy followed by surgery as a major trimodality strategy in locally advanced esophageal cancer, improving both R0 resection and long-term survival.
Primary source
Shapiro J, et al. Lancet Oncol. 2015;16:1090–1098.