Pathological Response and Clinical Outcomes in Locally Advanced Esophageal Cancer Following CROSS protocol

A BSTRACT Background: Neoadjuvant chemoradiotherapy (NACTRT) followed by surgery has become the treatment strategy for patients with locally advanced esophageal cancer (LAESCC). This study investigates the rate of pathological complete response (pCR) to NACTRT and assesses its impact on overall survival (OS) and cancer-specific mortality (CSM) in this cohort of patients. Methods: In this retrospective study, we analyzed data from 50 patients with locally advanced esophageal squamous cell carcinoma treated at our institution. Among the 50 patients, 28 patients completed NACTRT and underwent surgery (compliant), and the rest 22 completed NACTRT but did not undergo surgery or were lost to follow-up (noncompliant group). All patients received a radiation dose of 41.4 Gy in 23 fractions by intensity-modulated radiation therapy with concurrent weekly paclitaxel and carboplatin. Results: In the compliant group, 22 (78.5%) patients had pCR, 2 (8.7%) patients had near-complete response, and 4 (17.4%) patients had partial or no response. One-year OS was 75% in the compliant group versus 50% in the noncompliant group ( P < 0.001). One year OS was 91% among those who achieved complete response. CSM rates were lower in the compliant group (25%) than in the noncompliant group (54.5%). Conclusions: NACTRT followed by surgery was associated with improved OS and CSM rates in patients with locally advanced esophageal squamous cell carcinoma (LAESCC). These findings emphasize the importance of adherence to multimodal treatment protocols in this patient population.