# CROSS: preoperative chemoradiotherapy for oesophageal or junctional cancer

Source: https://onco.cc/key-papers/paper-cross-nejm-2012/  
OnCo record `paper-cross-nejm-2012` (Key paper). Data CC BY-NC 4.0, attribute "Data from OnCo (onco.cc)"; commercial use needs a licence.

## TL;DR

Five weeks of carboplatin-paclitaxel with radiotherapy before oesophagectomy lengthened median survival from 24 to 49 months in oesophageal cancer compared with surgery alone, with a complete pathological response in almost half of squamous cancers.

## Summary

Phase 3 trial of 366 patients with resectable oesophageal or junctional cancer (75 percent adenocarcinoma) randomised to weekly carboplatin-paclitaxel with 41.4 Gy radiotherapy followed by surgery, or surgery alone.

Median overall survival was 49.4 versus 24.0 months (hazard ratio 0.657), complete resection 92 versus 69 percent and pathological complete response 29 percent overall (49 percent in squamous cell carcinoma); the ten-year update confirmed the benefit.

## Fields

- Kind: Key paper
- Last checked: 2026-09-17
- Journal: New England Journal of Medicine
- Year: 2012
- DOI: 10.1056/NEJMoa1112088
- Authors: van Hagen P, Hulshof MC, van Lanschot JJ, et al.
- Findings: Median overall survival 49.4 vs 24.0 months; hazard ratio 0.657.; Pathological complete response 29 percent overall; 49 percent in squamous cell carcinoma.
- What it means: CROSS chemoradiotherapy is a standard for locally advanced oesophageal cancer, particularly squamous cell carcinoma; for adenocarcinoma, perioperative FLOT is now often preferred after ESOPEC.
- Caveats: Adenocarcinoma benefit was smaller than in squamous cell carcinoma.; Postoperative morbidity was not increased but the regimen requires fitness for surgery.

## Sources

- N Engl J Med 2012: https://doi.org/10.1056/NEJMoa1112088
- PubMed: https://pubmed.ncbi.nlm.nih.gov/22646630/

## Connected records

- cancers: [Oesophageal and junctional adenocarcinoma](https://onco.cc/cancers/oesophageal-adenocarcinoma/), [Oesophageal squamous cell carcinoma](https://onco.cc/cancers/oesophageal-squamous-cell-carcinoma/)
- trials: [CROSS](https://onco.cc/trials/cross/)
- journals: [New England Journal of Medicine](https://onco.cc/journals/nejm/)

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