{"entity":{"id":"idea-organ-preservation-esophageal","kind":"idea","name":"Organ preservation as the default after complete response in oesophageal cancer","aka":[],"tldr":"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.","asOf":"2026-09-07","links":[{"label":"ClinicalTrials.gov NCT05953181: SANO","url":"https://clinicaltrials.gov/study/NCT05953181"}],"tags":[],"related":[],"cancers":["esophageal"],"sections":[],"technologies":["active-surveillance","imrt-igrt","checkpoint-inhibitor","mrd-testing"],"targets":[],"drugs":[],"companies":[],"institutions":[],"pathways":[],"terms":["clinical-complete-response"],"trials":["sano","cross"],"people":[],"bottlenecks":[],"keyPapers":[],"journals":[],"dependsOn":[],"notes":[],"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.","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"},"route":"/ideas/idea-organ-preservation-esophageal/","neighbours":{"cancer":[{"id":"esophageal","kind":"cancer","name":"Oesophageal cancer","route":"/cancers/esophageal/"}],"technology":[{"id":"active-surveillance","kind":"technology","name":"Active surveillance","route":"/technologies/active-surveillance/"},{"id":"checkpoint-inhibitor","kind":"technology","name":"Immune checkpoint inhibitors","route":"/technologies/checkpoint-inhibitor/"},{"id":"imrt-igrt","kind":"technology","name":"IMRT / IGRT (modern external beam)","route":"/technologies/imrt-igrt/"},{"id":"mrd-testing","kind":"technology","name":"MRD / molecular residual disease testing","route":"/technologies/mrd-testing/"}],"term":[{"id":"clinical-complete-response","kind":"term","name":"Clinical complete response (cCR)","route":"/terms/clinical-complete-response/"}],"trial":[{"id":"cross","kind":"trial","name":"CROSS","route":"/trials/cross/"},{"id":"sano","kind":"trial","name":"SANO","route":"/trials/sano/"}],"bottleneck":[{"id":"b-surgery-radiation-innovation","kind":"bottleneck","name":"Surgery and radiotherapy cure most, get least","route":"/bottlenecks/b-surgery-radiation-innovation/"}]}}