{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,6]],"date-time":"2026-03-06T09:34:32Z","timestamp":1772789672295,"version":"3.50.1"},"reference-count":41,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"5","content-domain":{"domain":["lww.com","ovid.com"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2023,5]]},"abstract":"<jats:sec>\n            <jats:title>Objective:<\/jats:title>\n            <jats:p>This study aimed to compare the postoperative and pathological outcomes between carboplatin, paclitaxel, radiotherapy (CROSS) and 5-FU, leucovorine, oxaliplatin and docetaxel (FLOT) in esophageal adenocarcinoma (EAC) patients from an international, multicenter cohort.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Summary of Background Data:<\/jats:title>\n            <jats:p>Ongoing debate exists around optimum approach to locally advanced EAC, with proponents for perioperative chemotherapy, such as FLOT, or multimodal therapy, in particular the CROSS regimen.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Methods:<\/jats:title>\n            <jats:p>Patients undergoing CROSS (n = 350) and FLOT (n = 368), followed by curative esophagectomy for EAC were identified from the Oesophagogastric Anastomosis Audit.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Results:<\/jats:title>\n            <jats:p>The 90-day mortality was higher after CROSS than FLOT (5% vs 1%, <jats:italic toggle=\"yes\">P<\/jats:italic> = 0.005), even on adjusted analyses [odds ratio (OR): 3.97, confidence interval (CI)<jats:sub>95%<\/jats:sub>: 1.34\u201313.67]. Postoperative mortality in CROSS were related to higher pulmonary (74% vs 60%) and cardiac complications (42% vs 20%) compared to FLOT. CROSS was associated with higher pathologic complete response (pCR) rates (18% vs 10%, <jats:italic toggle=\"yes\">P<\/jats:italic> = 0.004) and margin-negative resections (93% vs 76%, <jats:italic toggle=\"yes\">P &lt;<\/jats:italic> 0.001) compared with FLOT. On adjusted analyses, CROSS was associated with higher pCR rates (OR: 2.05, CI<jats:sub>95%<\/jats:sub>: 1.26-3.34) and margin-negative resections (OR: 4.55, CI<jats:sub>95%<\/jats:sub>: 2.70-7.69) compared to FLOT.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Conclusions:<\/jats:title>\n            <jats:p>This study provides real-world data CROSS was associated with higher 90-day mortality than FLOT, related to cardio-pulmonary complications with CROSS. These warrant a further review into causes and mechanisms in selected patients, and at minimum suggest the need for strict radiation therapy quality assurance. Research into impact of higher pCR rates and R0 resections with CROSS compared to FLOT on long-term survival is needed.<\/jats:p>\n          <\/jats:sec>","DOI":"10.1097\/sla.0000000000005394","type":"journal-article","created":{"date-parts":[[2022,1,29]],"date-time":"2022-01-29T02:22:45Z","timestamp":1643422965000},"page":"e1026-e1034","update-policy":"https:\/\/doi.org\/10.1097\/lww.0000000000001000","source":"Crossref","is-referenced-by-count":25,"title":["Postoperative and Pathological Outcomes of CROSS and FLOT as Neoadjuvant Therapy for Esophageal and Junctional Adenocarcinoma"],"prefix":"10.1097","volume":"277","author":[{"name":"Oesophago-Gastric Anastomotic Audit (OGAA) Collaborative","sequence":"first","affiliation":[]}],"member":"276","published-online":{"date-parts":[[2023,4,6]]},"reference":[{"key":"R1-20250424","doi-asserted-by":"crossref","first-page":"2074","DOI":"10.1056\/NEJMoa1112088","article-title":"Preoperative chemoradiotherapy for esophageal or junctional cancer","volume":"366","year":"2012","journal-title":"N Engl J Med"},{"key":"R2-20250424","doi-asserted-by":"crossref","first-page":"403","DOI":"10.1093\/bjs\/znaa121","article-title":"Neoadjuvant chemoradiotherapy or chemotherapy alone for oesophageal cancer: population-based cohort study","volume":"108","year":"2021","journal-title":"Br J Surg"},{"key":"R3-20250424","doi-asserted-by":"crossref","first-page":"1948","DOI":"10.1016\/S0140-6736(18)32557-1","article-title":"Perioperative chemotherapy with fluorouracil plus leucovorin, oxaliplatin, and docetaxel versus fluorouracil or capecitabine plus cisplatin and epirubicin for locally advanced, resectable gastric or gastro-oesophageal junction adenocarcinoma (FLOT4): a randomised, phase 2\/3 trial","volume":"393","year":"2019","journal-title":"Lancet"},{"key":"R4-20250424","doi-asserted-by":"crossref","first-page":"11","DOI":"10.1056\/NEJMoa055531","article-title":"Perioperative chemotherapy versus surgery alone for resectable gastroesophageal cancer","volume":"355","year":"2006","journal-title":"N Engl J Med"},{"key":"R5-20250424","doi-asserted-by":"crossref","first-page":"1995","DOI":"10.1200\/JCO.20.03614","article-title":"Ten-year outcome of neoadjuvant chemoradiotherapy plus surgery for esophageal cancer: the randomized controlled CROSS trial","volume":"39","year":"2021","journal-title":"J Clin Oncol"},{"key":"R7-20250424","doi-asserted-by":"crossref","first-page":"267","DOI":"10.1002\/bjs.8968","article-title":"Recurrence pattern in patients with a pathologically complete response after neoadjuvant chemoradiotherapy and surgery for oesophageal cancer","volume":"100","year":"2013","journal-title":"Br J Surg"},{"key":"R8-20250424","doi-asserted-by":"crossref","first-page":"2063","DOI":"10.1245\/s10434-019-07316-9","article-title":"Differences in esophageal cancer surgery in terms of surgical approach and extent of lymphadenectomy: findings of an international survey","volume":"26","year":"2019","journal-title":"Ann Surg Oncol"},{"key":"R9-20250424","doi-asserted-by":"crossref","first-page":"2252","DOI":"10.1245\/s10434-017-5830-6","article-title":"TOPGEAR: a randomized, phase III trial of perioperative ECF chemotherapy with or without preoperative chemoradiation for resectable gastric cancer: interim results from an international, intergroup trial of the AGITG, TROG, EORTC and CCTG","volume":"24","year":"2017","journal-title":"Ann Surg Oncol"},{"key":"R10-20250424","doi-asserted-by":"crossref","first-page":"503","DOI":"10.1186\/s12885-016-2564-y","article-title":"ESOPEC: prospective randomized controlled multicenter phase III trial comparing perioperative chemotherapy (FLOT protocol) to neoadjuvant chemoradiation (CROSS protocol) in patients with adenocarcinoma of the esophagus (NCT02509286)","volume":"16","year":"2016","journal-title":"BMC Cancer"},{"key":"R11-20250424","doi-asserted-by":"crossref","first-page":"326","DOI":"10.29271\/jcpsp.2021.03.326","article-title":"CROSS or FLOT in distal esophageal and gastroesophageal cancer","volume":"31","year":"2021","journal-title":"J Coll Physicians Surg Pak"},{"key":"R12-20250424","doi-asserted-by":"crossref","first-page":"523","DOI":"10.1007\/s00262-019-02475-w","article-title":"Immune profile and immunosurveillance in treatment-naive and neoadjuvantly treated esophageal adenocarcinoma","volume":"69","year":"2020","journal-title":"Cancer Immunol Immunother"},{"key":"R13-20250424","doi-asserted-by":"crossref","first-page":"1572","DOI":"10.1016\/j.ejso.2017.06.003","article-title":"Neoadjuvant chemotherapy or chemoradiation for patients with advanced adenocarcinoma of the oesophagus? 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