CROSS
The trial that made chemotherapy plus radiation before surgery the standard for oesophageal cancer; the survival gain was still there ten years later.
OS 49.4 vs 24.0 months (NEJM 2012); pCR 29% (49% in squamous). Ten-year OS 38% vs 25% (JCO 2021), HR for death from oesophageal cancer 0.60. The CROSS regimen is the reference arm for CheckMate 577, SANO, and most modern trials; perioperative FLOT is the alternative for adenocarcinoma (ESOPEC 2024 favoured FLOT).
Setting
Resectable oesophageal or junctional cancer (squamous and adenocarcinoma): weekly carboplatin/paclitaxel + 41.4 Gy radiation then surgery vs surgery alone
Phase
Phase 3
Sponsor
Dutch Cancer Society (Erasmus MC)
Registry
Headline result
10-year OS 38% vs 25%; median OS 49.4 vs 24.0 months.
Reported
2012
Enrolled
366
Replication
Durable at 10 years; NEO-AEGIS and ESOPEC compared it against perioperative chemotherapy in adenocarcinoma with FLOT favoured in ESOPEC.
In plain words
What these results mean for people, not percentages
Overall survivalprimarysurvival endpoint
- Median 49.4 vs 24 months with Chemoradiation + surgery compared with Surgery alone; about 25.4 months longer for half the group.
- A median is a midpoint: half the people did better than this and half did worse, so it is not a prediction for any one person.
- Put another way, the treated group had about 32 percent lower chance of the event at any given time (hazard ratio 0.68).
Overall survival at 10 yearssurvival endpoint
- 38 vs 25 out of 100 alive at 10 years with Chemoradiation + surgery compared with Surgery alone; 13 more per 100.
- Roughly one extra person helped for every 8 treated. That is a rough figure taken from the two percentages, not a guarantee for any one person.
Be careful
- Overall survival counts deaths from any cause, so it is the most direct measure of whether a treatment helps people live longer.
- These results apply to the people the trial enrolled: Resectable oesophageal or junctional cancer (squamous and adenocarcinoma): weekly carboplatin/paclitaxel + 41.4 Gy radiation then surgery vs surgery alone. People in a different situation may not see the same effect.
Numbers are from the trial as recorded here; see the source links in the table below. This is orientation, not medical advice: ask your team how closely the trial population matches you.
366 participants enrolled.
| Endpoint | Arm | n | Value | HR (95% CI) | p | Source |
|---|---|---|---|---|---|---|
| Overall survivalprimary | Chemoradiation + surgery | 178 | 49.4 months | 0.68 | — | link |
| Surgery alone | 188 | 24 months | ||||
| Overall survival at 10 years | Chemoradiation + surgery | — | 38 percent | — | — | link |
| Surgery alone | — | 25 percent |
Replication
Durable at 10 years; NEO-AEGIS and ESOPEC compared it against perioperative chemotherapy in adenocarcinoma with FLOT favoured in ESOPEC.