{"entity":{"id":"sano","kind":"trial","name":"SANO","aka":[],"tldr":"For the third of patients whose tumour vanishes after chemoradiation, watching closely and operating only if it comes back gave the same survival as immediate surgery.","summary":"Stepped-wedge cluster-randomised non-inferiority trial (Lancet Oncology 2025). Two-year OS non-inferior (HR 1.14, 95% CI 0.74-1.78); about a third of surveillance patients avoided oesophagectomy at 2 years, with better short-term quality of life. Regrowth was usually resectable. Establishes organ preservation as an option for cCR, with caveats about surveillance intensity.","status":"positive","asOf":"2026-09-07","links":[{"label":"ClinicalTrials.gov NCT05953181","url":"https://clinicaltrials.gov/study/NCT05953181"},{"label":"Lancet Oncology 2025","url":"https://www.sciencedirect.com/science/article/abs/pii/S1470204525000270"}],"tags":[],"related":[],"cancers":["esophageal"],"sections":[],"technologies":["active-surveillance","imrt-igrt"],"targets":[],"drugs":[],"companies":[],"institutions":[],"pathways":[],"terms":["clinical-complete-response"],"trials":["cross"],"people":["jan-van-lanschot"],"bottlenecks":[],"keyPapers":[],"journals":[],"dependsOn":[],"notes":[],"nct":"NCT05953181","phase":"3","setting":"Oesophageal cancer with clinical complete response after CROSS chemoradiation: active surveillance (surgery only on regrowth) vs standard surgery","sponsor":"Erasmus MC","result":"2-year OS non-inferior (HR 1.14); ~one-third avoided surgery.","started":"2017-11-01","startedType":"actual","yearReported":2023,"enrolled":309,"enrolledBasis":"analysed","enrolledNote":"ClinicalTrials.gov lists 776 participants (actual); the Lancet Oncology 2025 paper reports 1,115 individuals screened and 309 included in the analysis (198 active surveillance, 111 standard surgery).","outcomes":[{"endpoint":"Overall survival at 2 years (non-inferiority)","primary":true,"arms":[{"name":"Active surveillance","n":156},{"name":"Standard surgery","n":118}],"hr":1.14,"ci":[0.74,1.78],"p":"0.55","source":"https://www.sciencedirect.com/science/article/abs/pii/S1470204525000270"}],"replication":"Consistent with preSANO and observational series; longer follow-up pending."},"route":"/trials/sano/","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":"imrt-igrt","kind":"technology","name":"IMRT / IGRT (modern external beam)","route":"/technologies/imrt-igrt/"}],"term":[{"id":"active-surveillance-term","kind":"term","name":"Active surveillance and observation","route":"/terms/active-surveillance-term/"},{"id":"clinical-complete-response","kind":"term","name":"Clinical complete response (cCR)","route":"/terms/clinical-complete-response/"},{"id":"cluster-randomised-trial","kind":"term","name":"Cluster-randomised trial","route":"/terms/cluster-randomised-trial/"},{"id":"non-inferiority-margin","kind":"term","name":"Non-inferiority margin and equivalence trials","route":"/terms/non-inferiority-margin/"},{"id":"non-inferiority","kind":"term","name":"Non-inferiority trial","route":"/terms/non-inferiority/"},{"id":"oesophagectomy","kind":"term","name":"Oesophagectomy","route":"/terms/oesophagectomy/"},{"id":"stepped-wedge-design","kind":"term","name":"Stepped-wedge design","route":"/terms/stepped-wedge-design/"}],"trial":[{"id":"cross","kind":"trial","name":"CROSS","route":"/trials/cross/"}],"person":[{"id":"jan-van-lanschot","kind":"person","name":"J. Jan B. van Lanschot","route":"/people/jan-van-lanschot/"}],"pairing":[{"id":"cross-then-nivolumab","kind":"pairing","name":"CROSS chemoradiation → surgery → adjuvant nivolumab if residual disease","route":"/pairings/cross-then-nivolumab/"}],"idea":[{"id":"idea-organ-preservation-esophageal","kind":"idea","name":"Organ preservation as the default after complete response in oesophageal cancer","route":"/ideas/idea-organ-preservation-esophageal/"}],"bottleneck":[{"id":"b-surgery-radiation-innovation","kind":"bottleneck","name":"Surgery and radiotherapy cure most, get least","route":"/bottlenecks/b-surgery-radiation-innovation/"}],"roadmap":[{"id":"surgery-roadmap","kind":"roadmap","name":"Surgery roadmap: radical operations → less surgery → no surgery when a drug has done the work","route":"/roadmaps/surgery-roadmap/"}]}}