How would you manage a patient who received neoadjuvant CRT per the CROSS trial for esophageal cancer, but refuses surgery after imaging shows a good radiographic response?

That's a great question.

It is not evidence based, but with carbo/taxol (CROSS approach), I sometimes will go to 50.4 in case this very situation occurs. It's very well tolerated with conformal approach (the study treated with 41.4 Gy with AP-PA fields).

If it has already happened, and too much ti...

Something to consider when using the xrt dose from CROSS. I generally stick to 45-50.4 for that reason.

Not much one can do if more than a few weeks have passed