P1.056. FLOT vs CROSS Neoadjuvant Regimens in Esophageal and Esophagogastric Junction Adenocarcinomas: Meta-Analysis of Matched Patient Populations
Abstract
Esophageal Cancer: Adjuvant and Neo-Adjuvant Therapies Neoadjuvant treatment followed by surgical resection is standard of care for locally advanced oesophageal adenocarcinoma. Recent evidence has indicated that FLOT chemotherapy offers superior survival to CROSS chemoradiotherapy in this cohort. This study aims to meta-analyse all matched patient data comparing these two treatment regimens. A systematic review of PubMed, Scopus and EMBASE was performed from January 2010 to December 2025. Randomized controlled trials (RCT) and propensity score matched studies (PSM) directly comparing FLOT and CROSS were included for analysis. Risk of bias was assessed using the Cochrane Risk of Bias 2 tool for RCTs and the ROBINS-I tool for non-randomised studies. A meta-analysis using random effects model was performed examining overall survival, three-year survival, R0 resection, pathological complete response rate (pCR) and peri-operative morbidity. 4 studies (One RCT, 3 PSM studies) comprising 824 patients were eligible for analysis. The pooled hazard ratio for overall survival significantly favoured FLOT (HR 0.79, CI 0.68 – 0.93). However, survival at three years was similar between the two regimens (OR 1.19, CI 0.89 – 1.60). There was no significant difference observed in achieving R0 resections (OR 0.77, CI 0.33 – 1.77) or pCR (OR 0.87, CI 0.45 – 1.70). With regards to perioperative outcomes, there were no differences observed in mortality (OR 0.54, CI 0.21 – 1.40), anastomotic dehiscence (OR 0.8, CI 0.48 – 1.34) or other major complications (OR 1.04, CI 0.71 – 1.5). The result of this meta-analysis provides further evidence that perioperative FLOT chemotherapy confers a survival advantage over CROSS chemoradiotherapy in oesophageal adenocarcinoma. Additionally, CROSS chemoradiation did not appear to provide benefit in complete response rate or in achieving negative surgical margins when compared to chemotherapy alone.