Summary Background and objectives Since the first results of the Dutch randomized CROSS-trial, neoadjuvant chemoradiotherapy (CRT) using carboplatin and paclitaxel followed by resection for primary resectable nonmetastatic esophageal cancer (EC) has been implemented as standard curative treatment in the Netherlands. The purpose of this retrospective study is to evaluate the clinical outcomes of this treatment in daily practice in a large academic hospital. Methods Medical records of patients treated for primary resectable nonmetastatic EC between May 2010 and December 2015 at our institution were reviewed. Treatment consisted of five weekly courses of carboplatin (area under the curve 2) and paclitaxel (50 mg/m2) with concurrent external beam radiotherapy (23 fractions of 1.8 Gy), followed by transthoracic or transhiatal resection. Data on survival, progression, acute and late toxicity were recorded. Results A total of 145 patients were included. Median follow-up was 43 months. Median overall survival (OS) and progression-free survival (PFS) were 35 (95% confidence interval [CI] 29.8–40.2) and 30 (95% CI 19.7–40.3) months, respectively, with corresponding 3-year OS and PFS of 49.6% (95% CI 40.4–58.8) and 45.6% (95% CI 36.6–54.6). Acute toxicity grade ≥3 was observed in 25.5% of patients. Late adverse events grade ≥3 were seen in 24.8%, mostly esophageal stenosis. Conclusion Neoadjuvant CRT followed by resection for primary resectable nonmetastatic EC in daily practice results in a 3-year OS of 49.6% (95% CI 40.4–58.8) and PFS of 45.6% (95% CI 36.6–54.6), compared with 58% (51–65%) and 51% (43–58%) within the CROSS-trial. The slightly poorer survival in our daily practice group might be due to the presence of less favorable patient and tumor characteristics in daily practice, as is to be expected in daily practice. Toxicity was comparable with that in the CROSS-trial and considered acceptable.

中文翻译：

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新辅助放化疗后食管癌切除术：“CROSS 方案”在日常实践中的临床结果

摘要 背景和目标 自荷兰随机 CROSS 试验的第一个结果以来，使用卡铂和紫杉醇的新辅助放化疗 (CRT) 随后切除原发性可切除非转移性食管癌 (EC) 已作为标准治疗在荷兰实施。这项回顾性研究的目的是在大型学术医院的日常实践中评估这种治疗的临床结果。方法回顾2010年5月至2015年12月在我院接受原发性可切除非转移性EC治疗的患者病历。治疗包括 5 个每周疗程的卡铂（曲线 2 下面积）和紫杉醇（50 mg/m2），同时外照射放疗（23 次 1.8 Gy），然后进行经胸或经食管切除。记录有关生存、进展、急性和晚期毒性的数据。结果共纳入145例患者。中位随访时间为 43 个月。中位总生存期 (OS) 和无进展生存期 (PFS) 分别为 35 个月（95% 置信区间 [CI] 29.8-40.2）和 30 个月（95% CI 19.7-40.3）个月，相应的 3 年 OS 和 PFS 49.6% (95% CI 40.4–58.8) 和 45.6% (95% CI 36.6–54.6)。在 25.5% 的患者中观察到急性毒性 ≥3 级。24.8% 的晚期不良事件发生率≥3 级，主要是食管狭窄。结论 在日常实践中，新辅助 CRT 后切除原发性可切除非转移性 EC 的 3 年 OS 为 49.6%（95% CI 40.4-58.8）和 PFS 为 45.6%（95% CI 36.6-54.6），而 58% (51–65%) 和 51% (43–58%) 在 CROSS 试验中。我们日常实践组的生存率稍差可能是由于日常实践中存在不太有利的患者和肿瘤特征，这在日常实践中是可以预料的。毒性与 CROSS 试验中的毒性相当，被认为是可以接受的。