Outcomes of Neoadjuvant Chemoradiotherapy Using Volumetric Modulated Arc Therapy in Locally Advanced Squamous Cell Oesophageal Cancers

Sep 23, 2026

Neoadjuvant chemoradiotherapy is standard care for locally advanced oesophageal cancer, yet evidence largely reflects Western adenocarcinoma populations. This study evaluates outcomes of neoadjuvant chemoradiotherapy using the CROSS protocol with volumetric modulated arc therapy (VMAT) in locally advanced squamous cell oesophageal cancers. A retrospective cohort of 102 patients treated between 2021 and 2022 reports 3-year overall survival 72%, disease-free survival 59.1%, local control 72%, and pathological complete response 59.4%. Surgical complications with major Clavien–Dindo (≥3) occurred in 32%, with reduced pulmonary (17.7%) and cardiac (5.2%) events, supporting the approach’s efficacy and toxicity profile.

LanguageEnglish

CategoryHealthcare

FormatPDF

Pages9

Reading Time23 min

AccessFree to download

Abstract

Introduction

Background on oesophageal cancer histology

Evidence for neoadjuvant chemoradiotherapy trials

Methods

Results

Conclusions

Journal of Gastrointestinal Cancer (2025) 56:118 [https://doi.org/10.1007/s12029-025-01225-9](https://doi.org/10.1007/s12029-025-01225-9) Outcomes of Neoadjuvant Chemoradiotherapy Using Volumetric Modulated Arc Therapy in Locally Advanced Squamous Cell Oesophageal Cancers Sam David1 · Naveen Mummudi1 · AnilTibdewal1 · Sabita Jiwnani2 · KarthikV.2 · Kumar Prabhash3 · Trupti Pai4 · Jai Prakash Agarwal1 Accepted: 6 April 2025 © The Author(s) 2025 Abstract Purpose Neoadjuvant chemoradiotherapy has been established as the standard of care for locally advanced oesophageal cancers. Most of the evidences on neoadjuvant chemoradiotherapy (NACTRT) comes from the Western world where the predominant histology is adenocarcinoma. This study aimed to study the outcomes of neoadjuvant chemoradiotherapy using CROSS protocol and volumetric modulated arc therapy (VMAT) in locally advanced squamous cell oesophageal cancers. Case Presentation. We report a multicentric abdominal inflammatory myofibroblastic tumor in a 6-year-old girl who presented with massive abdominal distention. The sheer size of the mass, coupled with multicentric presentation and absent mobility on clinical examination, would have led to a very morbid surgical exploration. This patient was treated with initial chemotherapy, which led to a dramatic response in both symptoms and size of masses, facilitating a complete surgical resection with negligible postoperative morbidity. Methods This was a single-institute retrospective analysis utilizing a prospectively collected database where all patients with locally advanced operable oesophageal cancers with squamous histology diagnosed between 2021 and 2022 were screened and included. All patients received neoadjuvant chemoradiotherapy in accordance with the CROSS protocol with all patients receiving radiotherapy using VMAT technique. Results A total of 102 patients with locally advanced oesophageal cancers with squamous histology were included in the study. The median follow-up for the cohort was 29 months. The 3-year overall survival (OS), disease-free survival (DFS), and local control (LC) were 72%, 59.1%, and 72%, respectively. Pathological complete response was 59.4% . The major Clavien–Dindo classification (≥ class 3) of surgical complications was 32% . Lower incidence of pulmonary (17.7%) and cardiac (5.2%) complications was observed in this cohort. Conclusions NACTRT using the CROSS protocol enhances the pathological complete response rates and the survival outcomes in locally advanced oesophageal cancers with squamous histology. The utilization of VMAT has been associated with a reduction in postoperative cardiopulmonary toxicities. However, further prospective randomised studies are required to validate the technique’s superiority. Keywords Neoadjuvant chemoradiotherapy · Squamous cell oesophageal cancers · Volumetric modulated arc therapy Introduction Oesophageal cancer is the 11 th most commonly diagnosed malignancy in the world and the seventh leading cause of cancer mortality worldwide [1] . In the late 1960 s, oesophageal squamous cell carcinoma (ESCC) was the dominant Extended author information available on the last page of the article histological type in both Western and Eastern regions [2] . However, since the late 1990 s, there has been a notable shift in the predominant histology from the Orient to the Occident with the incidence of oesophageal adenocarcinoma (EAC) rising in the Western world [3] . Beyond the histopathological and epidemiological distinctions between EAC and ESCC, molecular differences were also noted in the pathogenesis of both histologies [4–7] . While ESCC was similar to squamous carcinoma occurring in the other parts of the body, EAC resembled an unstable chromosomal variant of gastric cancer. A sound understanding of the inherent differences in the epidemiology, pathology, and genomics of these two histologies will aid in rationalising the differences in respon

FAQs

What treatment approach was evaluated for locally advanced squamous cell oesophageal cancers?

The study assessed neoadjuvant chemoradiotherapy delivered according to the CROSS protocol, with radiotherapy delivered using VMAT.

What were the main survival and tumor-response outcomes reported?

Among 102 included patients, 3-year overall survival was 72%, disease-free survival 59.1%, local control 72%, and pathological complete response was 59.4%.

How did postoperative complications and cardiopulmonary toxicities compare?

Major surgical complications (Clavien–Dindo ≥3) occurred in 32%, with lower incidence of pulmonary complications (17.7%) and cardiac complications (5.2%) in the cohort.

Sep 23, 2026

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