What does this research mean for the field?

Following neoadjuvant CROSS therapy for esophageal cancer, systemic recurrence is the primary driver of mortality, particularly in non-pCR patients, though a small subset of pCR patients also remains at risk for distant failure. Novelty: ClaimNovelty.CONFIRMATORY. Consensus alignment: ConsensusAlignment.SUPPORTS_CONSENSUS.

What question did this study set out to answer?

To characterize the specific timing, rates, and patterns of locoregional versus systemic recurrence in esophageal cancer patients following neoadjuvant CROSS chemoradiotherapy and esophagectomy.

August 24, 2026Diseases of the EsophagusOpen Access

P1.145. The pCR Paradox: Unmasking Systemic Failure in Esophageal Cancer Following Neoadjuvant CROSS Therapy

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To characterize the specific timing, rates, and patterns of locoregional versus systemic recurrence in esophageal cancer patients following neoadjuvant CROSS chemoradiotherapy and esophagectomy.
Single-institution prospective study tracking 99 patients with resectable esophageal carcinoma (85.45% squamous cell carcinoma, 9.09% adenocarcinoma, 5.45% adenosquamous) between January 2015 and December 2025.
Patients underwent neoadjuvant CROSS therapy (41.4 Gy radiation with weekly paclitaxel/carboplatin) followed by PET-CT restaging and radical esophagectomy at 6–8 weeks.
Stratified recurrence patterns and survival outcomes between pathological complete response (pCR) and non-pCR groups over a median follow-up of 27.8 months.
Pathological complete response occurred in 56% of patients; pCR patients experienced locoregional failure of 7% and distant metastasis of 4.7%, whereas non-pCR patients had 15.9% locoregional and 22.9% systemic recurrence.
Systemic relapses occurred predominantly in the lungs, non-regional lymph nodes, bone, and liver, with most recurrences emerging within 30 to 48 months post-surgery.
Mean survival favored pCR patients (95% CI: 6.8–8.9 years) compared to non-pCR patients (95% CI: 3.9–7.4 years; p=0.061).

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Implication

Prospective cohort study reveals persistent systemic recurrence risk despite pathological complete response after CROSS therapy in esophageal cancer, indicating the need for adjuvant treatment.

Cite This Study

Jethani et al. (2026) studied this question.

synapsesocial.com/papers/6a8c009fbca056c88e6df6af https://doi.org/10.1093/dote/doag077.293

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Implication

Prospective cohort study reveals persistent systemic recurrence risk despite pathological complete response after CROSS therapy in esophageal cancer, indicating the need for adjuvant treatment.

P1.145. The pCR Paradox: Unmasking Systemic Failure in Esophageal Cancer Following Neoadjuvant CROSS Therapy

Key Points

Discussion

Implication

Cite This Study

P1.145. The pCR Paradox: Unmasking Systemic Failure in Esophageal Cancer Following Neoadjuvant CROSS Therapy

Key Points

Discussion

Implication

Cite This Study