Preoperative Chemoradiotherapy for Esophageal or Junctional Cancer

SUMMARY: In this trial, neoadjuvant chemoradiation followed by surgery was compared with surgery alone, in patients with esophageal or GE junction tumors. Three hundred and sixty six (366) patients were randomized and chemoradiotherapy consisted of weekly PARAPLATIN® (Carboplatin) and TAXOL® (Paclitaxel) for 5 weeks with concurrent radiotherapy followed by surgery. Complete resection was feasible in 92% of the patients receiving chemoradiation compared to 69% in the surgery alone group (P<0.001). Overall survival was 49 months in the chemoradiation/surgery group compared to 24 months in the surgery alone group (HR=0.65, P<0.003). This benefit was seen regardless of histology and postoperative complications were similar in both treatment groups. This study has conclusively established that chemoradiation followed by surgery is superior to surgery alone, in patients with esophageal and GE junction tumors. van Hagen P, Hulshof MCCM, van Lanschot JJB, et al. for the CROSS Group. N Engl J Med 2012; 366:2074-2084