Study Overview

The trial, known as SANO, involved 1,309 patients from 12 Dutch hospitals, who were enrolled between November 2017 and January 2021. Participants were randomly allocated to either active surveillance (198 patients) or standard esophagectomy (111 patients) after achieving a clinical complete response to chemotherapy and radiotherapy treatment.

The neoadjuvant chemoradiotherapy regimen consisted of five weekly cycles of the chemotherapy drugs paclitaxel and carboplatin, followed by a total of 41.4 Gy of external-beam radiotherapy administered in 23 fractions. The primary goal of this trial was to assess overall survival rates in a modified intent-to-treat analysis, permitting crossover to surgery at clinical complete response, alongside the broader intent-to-treat population.

Key Findings

With a median follow-up of 38 months, the study reported interesting survival statistics. At the two-year mark, the active surveillance group showed an overall survival rate of 74%, compared to 71% for the surgical group. These outcomes were statistically noninferior, as demonstrated by a hazard ratio of 1.14 (95% CI: 0.74–1.78). In broader terms, the intent-to-treat analysis revealed a 2-year survival rate of 75% for active surveillance, versus 70% for surgery, again validating the efficacy of watching closely rather than operating immediately.

The researchers noted that postoperative complications and mortality rates were comparable in both groups, indicating that postponing surgery did not carry additional risks.

Conclusion and Implications

The authors concluded that "overall survival after active surveillance for esophageal cancer was noninferior compared with standard surgery after 2 years." As they highlighted, these findings are critical for clinicians involved in patient counseling and decision-making regarding treatment options.

Future research is necessary to determine the long-term efficacy of active surveillance, but this trial has already laid the groundwork for changing conventional treatment paradigms in esophageal cancer. If you or a loved one are facing a diagnosis of esophageal cancer, this emerging strategy could reflect a promising approach worth discussing with your healthcare team.

Stay tuned for more updates on this groundbreaking study and its implications for cancer treatment!