From the Guidelines
The CROSS trial did not consider adjuvant chemoradiotherapy (CRT) as it focused on neoadjuvant chemoradiotherapy followed by surgery for patients with esophageal or gastroesophageal junction cancers. The trial evaluated the effectiveness of neoadjuvant CRT, which consisted of weekly carboplatin and paclitaxel with concurrent radiotherapy, compared to surgery alone 1. The primary endpoint was overall survival, and the trial demonstrated significant benefits with the neoadjuvant approach, showing improved overall survival and complete resection rates compared to surgery alone. Some key points to consider:
- The CROSS trial established neoadjuvant chemoradiotherapy as a standard of care for locally advanced esophageal cancer, rather than adjuvant therapy which would be administered after surgery 1.
- The trial did not include adjuvant (post-operative) CRT as part of its treatment protocol, focusing specifically on the neoadjuvant approach 1.
- Other studies have examined the role of adjuvant chemoradiotherapy in different types of cancer, such as pancreatic cancer, but the CROSS trial did not consider this approach 1.
- The use of adjuvant therapy is not considered standard therapy for some types of cancer, and further studies are needed to determine its potential benefits 1.
From the Research
Adjuvant Chemoradiotherapy in Rectal Cancer
- The use of adjuvant chemoradiotherapy in rectal cancer is a topic of ongoing research and debate 2.
- Studies have investigated the efficacy of different chemotherapy regimens, including 5-fluorouracil (5-FU) and capecitabine, in combination with radiation therapy 3, 4.
- A meta-analysis comparing 5-FU-based and capecitabine-based neoadjuvant chemoradiotherapy in patients with rectal cancer found no significant difference in tumor down-staging rate, pathologic complete response, or survival rates between the two groups 4.
- Another study found that the addition of oxaliplatin to 5-FU or capecitabine did not improve local-regional control, disease-free survival, or overall survival, but did increase toxicity 3.
Consideration of Adjuvant CRT in Cross-Trial
- A review of 24 randomized controlled trials on adjuvant treatment of rectal cancer found that most data did not support the use of postoperative adjuvant chemotherapy for patients already treated with preoperative (chemo) radiotherapy 2.
- However, some studies suggest that adjuvant chemotherapy may be beneficial for patients who did not receive preoperative (chemo) radiotherapy 2, 5.
- A phase 2 study found that neoadjuvant chemotherapy with liposomal irinotecan, 5-fluorouracil, leucovorin, and oxaliplatin, followed by chemoradiotherapy, was a safe and effective therapeutic alternative for the management of locally advanced rectal cancer 6.
Key Findings
- The current standard-of-care adjuvant treatment for patients with colorectal cancer comprises a fluoropyrimidine (5-fluorouracil or capecitabine) as a single agent or in combination with oxaliplatin 5.
- Patient stratification and personalization of therapy are areas of ongoing research, with the goal of improving treatment outcomes and reducing toxicity 5.