# Organ preservation as the default after complete response in oesophageal cancer

Source: https://onco.cc/ideas/idea-organ-preservation-esophageal/  
OnCo record `idea-organ-preservation-esophageal` (Idea). Data CC BY-NC 4.0, attribute "Data from OnCo (onco.cc)"; commercial use needs a licence.

## TL;DR

Oesophagectomy is one of the hardest operations in surgery. If chemoradiation (with or without immunotherapy) has made the tumour disappear, skip it and watch.

## Summary

SANO showed non-inferior 2-year survival for active surveillance in clinical complete responders after CROSS. Adding PD-1 blockade to chemoradiation (KEYNOTE-975, SKYSCRAPER-07, ESCORT-CRT) may raise complete response rates and make surveillance viable for more patients; ctDNA and PET could sharpen response assessment.

## Fields

- Kind: Idea
- Last checked: 2026-09-07
- Hypothesis: Definitive chemoradiation + PD-1 blockade followed by ctDNA- and endoscopy-guided surveillance, with salvage surgery on regrowth, yields non-inferior 3-year OS to planned oesophagectomy in squamous cell carcinoma.
- Rationale: ESCC is highly radiosensitive and immunotherapy-responsive; salvage surgery after regrowth was feasible in SANO.
- Proposed test: Randomised non-inferiority trial in ESCC with cCR after chemoradiation-IO; OS primary, oesophagectomy-free survival and quality of life secondary.
- Maturity: being-tested-at-scale

## Sources

- ClinicalTrials.gov NCT05953181: SANO: https://clinicaltrials.gov/study/NCT05953181

## Connected records

- cancers: [Oesophageal cancer](https://onco.cc/cancers/esophageal/)
- technologies: [Active surveillance](https://onco.cc/technologies/active-surveillance/), [Immune checkpoint inhibitors](https://onco.cc/technologies/checkpoint-inhibitor/), [IMRT / IGRT (modern external beam)](https://onco.cc/technologies/imrt-igrt/), [MRD / molecular residual disease testing](https://onco.cc/technologies/mrd-testing/)
- terms: [Clinical complete response (cCR)](https://onco.cc/terms/clinical-complete-response/)
- trials: [CROSS](https://onco.cc/trials/cross/), [SANO](https://onco.cc/trials/sano/)
- bottlenecks: [Surgery and radiotherapy cure most, get least](https://onco.cc/bottlenecks/b-surgery-radiation-innovation/)

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