585. INDIAN SINGLE CENTRE EXPERIENCE USING CROSS PROTOL IN CARCINOMA ESOPHAGUS AND GASTROESOPHAGEAL JUNCTION (GEJ)

Last decade has changed the treatment modality in esophageal cancer. Neoadjuvant chemoradiation followed by surgery is proven to be highly effective in locally advanced esophageal and GEJ tumors by Dutch CROSS protocol. The aim of neoadjuvant treatment is to increase R0 resection, down staging and pathological complete response which eventually increases disease free and overall survival. This is a prospective observational single arm study of 51 patients who were treated with neoadjuvant chemoradiation with radiation therapy (RT) to 41.4 Gy/23 Fr/4.5 weeks and weekly paclitaxel and carboplatin, followed by surgery at our institute between 2013 and 2021. Eligibility for the use of CROSS protocol was expanded beyond the clinical stage T1N1 or T2-3N0-1, which includes T4aN0-1, T3N2-3. The median age of this cohort was 58 years. 37/51 (72%) had T3 disease, 8/51 (15%) had T4a and 14/51 (27%) had N2/N3 disease. 90% patients had squamous cell carcinoma. All patients completed the intended dose of radiation; 11/51 (22%) patients had a treatment delay due to haematological toxicity; one patient died. 42 (82%) successfully completed esophagectomy with R0; one patient had inoperable disease, four defaulted and three refused surgery; 26 (62%) had pCR, 12 (28.57%) PR and one had SD. At last follow up 35 patients were alive, 12 died of disease and 7 had recurrent disease. Our experience of neoadjuvant chemo radiation therapy (CROSS protocol) is in line with published data. Surgery post induction therapy was not associated with increased morbidity. It was associated with high complete resections and pathological complete response.