Top Line:The Dutch SANO trial established non-inferior survival with close surveillance when compared to immediate surgery in patients who achieve a complete response to neoadjuvant chemoradiation for locally-advanced esophageal cancer.
The Study: So we know delayed salvage esophagectomy can still be safe and effective, but common sense would suggest the sooner the better for the roughly half of surveillance patients who prove to ultimately require one. Wouldn’t it be great to know which ones are at highest risk? Enter this secondary analysis of the 37% of SANO enrollees who achieved a clinical complete response at 12 weeks and entered active surveillance in lieu of immediate surgery. Of those, only one in four maintained a sustained response at ~4.5 years median follow-up. The only consistent clinical predictor of both initial and sustained complete response was lower nodal burden. No other routinely available variables (age, histology, grade, tumor site, length, or performance status) meaningfully predicted response.
TBL: Safely delaying esophagectomy remains worthwhile, but a non-invasive sensitive surveillance tool would certainly optimize this strategy and we imagine some ctDNA company somewhere agrees. | Panday, Ann Surg Oncol 2025
The Study: So we know delayed salvage esophagectomy can still be safe and effective, but common sense would suggest the sooner the better for the roughly half of surveillance patients who prove to ultimately require one. Wouldn’t it be great to know which ones are at highest risk? Enter this secondary analysis of the 37% of SANO enrollees who achieved a clinical complete response at 12 weeks and entered active surveillance in lieu of immediate surgery. Of those, only one in four maintained a sustained response at ~4.5 years median follow-up. The only consistent clinical predictor of both initial and sustained complete response was lower nodal burden. No other routinely available variables (age, histology, grade, tumor site, length, or performance status) meaningfully predicted response.
TBL: Safely delaying esophagectomy remains worthwhile, but a non-invasive sensitive surveillance tool would certainly optimize this strategy and we imagine some ctDNA company somewhere agrees. | Panday, Ann Surg Oncol 2025