Effect of Extending the Original Eligibility Criteria for the CROSS Neoadjuvant Chemoradiotherapy on Toxicity and Survival in Esophageal Cancer

• Published in: Annals of surgical oncology Vol. 24; no. 7; pp. 1811 - 1820
• Main Authors: de Heer, E. C., Hulshoff, J. B., Klerk, D., Burgerhof, J. G. M., de Groot, D. J. A., Plukker, J. Th. M., Hospers, G. A. P.
• Format: Journal Article
• Language: English
• Published: Cham Springer International Publishing 01.07.2017; Springer Nature B.V
• Subjects: Adenocarcinoma - mortality; Adenocarcinoma - secondary; Adenocarcinoma - therapy; Aged; Antineoplastic Combined Chemotherapy Protocols - therapeutic use; Carcinoma, Squamous Cell - mortality; Carcinoma, Squamous Cell - secondary; Carcinoma, Squamous Cell - therapy; Chemoradiotherapy; Chemoradiotherapy - mortality; Chemotherapy; Combined Modality Therapy; Esophageal cancer; Esophageal Neoplasms - mortality; Esophageal Neoplasms - pathology; Esophageal Neoplasms - therapy; Esophagectomy - mortality; Esophagus; Female; Follow-Up Studies; Gastrointestinal Oncology; Humans; Lymph; Lymph nodes; Lymphatic Metastasis; Male; Medical prognosis; Medicine; Medicine & Public Health; Metastases; Middle Aged; Mortality; Neoadjuvant Therapy - mortality; Neoplasm Invasiveness; Oncology; Prognosis; Prospective Studies; Radiation therapy; Retrospective Studies; Stomach; Surgery; Surgical Oncology; Survival; Survival Rate; Toxicity; Celiac Lymph Node; Esophageal Cancer; Original Cross; Overall Survival; Tumor Length
• ISSN: 1068-9265; 1534-4681
• DOI: 10.1245/s10434-017-5797-3

Background Patients with curable esophageal cancer (EC) who proceed beyond the original Chemoradiotherapy for Oesophageal Cancer Followed by Surgery Study (CROSS) eligibility criteria are also treated with neoadjuvant chemoradiotherapy (nCRT). This study assessed the effect that extending the CROSS eligibility criteria for nCRT has on treatment-related toxicity and overall survival (OS) in EC. Methods The study enrolled 161 patients with locally advanced EC (T1N1-3/T2-4aN0-3/M0) treated with the CROSS schedule followed by esophagectomy. Group 1 consisted of 89 patients who met the CROSS criteria, and group 2 consisted of 72 patients who met the extended eligibility criteria, i.e. a tumor length greater than 8 cm ( n  = 24), more than 10% weight loss ( n  = 35), more than 2–4 cm extension in the stomach ( n  = 21), celiac lymph node metastasis ( n  = 13), and/or age over 75 years ( n  = 2). The study assessed the differences in nCRT-associated toxicity [National Cancer Institute’s Common Terminology Criteria for Adverse Events (CTCAE) grade ≥ 3] and 90-day postoperative mortality. Moreover, the prognostic value for OS was assessed with multivariate Cox regression analysis. Results No difference was found in nCRT-associated toxicity ( P  = 0.117), postoperative complications ( P  = 0.783), and 90-day mortality ( P  = 0.492). The OS differed significantly ( P  = 0.004), with a median of 37.3 months [95% confidence interval (CI), 10.4–64.2 months] for group 1 and 17.2 months (95% CI 13.8–20.7 months) for group 2. Pathologic N stage ( P  = 0.023), pathologic T stage ( P  = 0.043), and group 2 ( P  = 0.008) were independent prognostic factors for OS. Conclusions Extension of the CROSS study eligibility criteria for nCRT did not affect nCRT-associated toxicity, postoperative complications, and postoperative mortality, but was prognostic for OS.