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.