[食道癌] Cross study

Cross study 是一篇非常有名的食道癌研究,改變了食道癌的治療方法, 讓大家知道在locally advanced esophageal cancer, neoadjuvant CCRT + surgery是一個可行的治療

其研究內容如下, resectable esophageal ca or esophagogastric junction cancer (clinical stage T1N1M0 or T2–3N0–1M0), 分成 neoadjuvant CCRT(41.4Gy/23Fr + carboplatin + paclitaxel) + surgery v.s. surgery alone, 結果發現加上neoadjuvant CCRT 明顯改善 Median Survival (49m v.s. 24m), 非血液學的副作用在兩組沒有差別, 手術R0 resection(92% v.s. 69%, P<0.001), CCRT組的ypCR有29%, 其中pCR 在 adenocarcinoma (23%) versus squamous-cell carcinoma (49%) (P=0.008)

後來在2015年在lancet 發表長期追蹤的結果(median follow-up = 84.1 months), 確認不管是在adenocarcinoma or squamous carcinoma, 做neoadjuvant CCRT 都對OS 有幫助!

2021年又發表了十年長期追蹤結果(median follow-up:147 months), 發現neoadjuvant CRT 有比較好的 overall survival (hazard ratio [HR], 0.70; 95% CI, 0.55 to 0.89); 而且這個效應跟時間無關; 10年的overall survival benefit 是 38% v.s. 25%

表格整理如下:

MS = median overall survival; OS = overall survival

reference:
1. van Hagen, Pieter, et al. "Preoperative chemoradiotherapy for esophageal or junctional cancer." New England Journal of Medicine 366.22 (2012): 2074-2084.

2. Shapiro, Joel, et al. "Neoadjuvant chemoradiotherapy plus surgery versus surgery alone for oesophageal or junctional cancer (CROSS): long-term results of a randomised controlled trial." The lancet oncology 16.9 (2015): 1090-1098.

3. Ten-Year Outcome of Neoadjuvant Chemoradiotherapy Plus Surgery for Esophageal Cancer: The Randomized Controlled CROSS Trial