CROSS Trial's Chemoradiation Regimen Improves Survival in GEJ Cancer

Key Insights

• The CROSS trial demonstrated that neoadjuvant chemoradiation with carboplatin and paclitaxel significantly improves survival rates in patients with gastroesophageal junction (GEJ) cancer compared to surgery alone.
• The CROSS regimen involves a 5-week course of carboplatin and paclitaxel combined with concurrent radiotherapy, followed by surgery, leading to more durable disease control.
• Published in 2012, the CROSS trial has transformed the treatment approach for GEJ cancers, establishing chemoradiation as a standard neoadjuvant therapy.

The CROSS trial, a landmark study published in 2012, has significantly impacted the treatment of gastroesophageal junction (GEJ) cancers by demonstrating improved survival rates with neoadjuvant chemoradiation. The trial compared surgery alone to a combination of chemotherapy and radiation therapy followed by surgery, establishing a new standard of care.

The CROSS Trial: A Paradigm Shift

Prior to the CROSS trial, surgeons primarily relied on surgery to treat GEJ cancers. However, high recurrence rates prompted the search for more effective treatment strategies. According to Dr. Yanghee Woo, the CROSS trial put the chemo and radiation combination on the map for neoadjuvant therapy.

The CROSS trial regimen consists of carboplatin and paclitaxel administered over 5 weeks, combined with concurrent radiotherapy (41.4 Gy in 23 fractions), followed by surgery. Patients underwent the neoadjuvant regimen for approximately 29 days, with surgery performed about 6 weeks later.

Improved Survival and Disease Control

The key finding of the CROSS trial, published in the New England Journal of Medicine, is that chemoradiation before surgery improves survival in patients with GEJ tumors. This approach not only extends survival but also provides more durable disease control, marking a significant advancement in the treatment of this challenging cancer.