# SANO

Source: https://onco.cc/trials/sano/  
OnCo record `sano` (Trial). Data CC BY-NC 4.0, attribute "Data from OnCo (onco.cc)"; commercial use needs a licence.

## TL;DR

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.

## Fields

- Kind: Trial
- Status: positive
- Last checked: 2026-09-07
- Registry id: 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
- Enrolled: 309
- Result: 2-year OS non-inferior (HR 1.14); ~one-third avoided surgery.
- Outcomes: Overall survival at 2 years (non-inferiority): Active surveillance vs Standard surgery, HR 1.14
- Replication: Consistent with preSANO and observational series; longer follow-up pending.

## Sources

- ClinicalTrials.gov NCT05953181: https://clinicaltrials.gov/study/NCT05953181
- Lancet Oncology 2025: https://www.sciencedirect.com/science/article/abs/pii/S1470204525000270

## Connected records

- cancers: [Oesophageal cancer](https://onco.cc/cancers/esophageal/)
- technologies: [Active surveillance](https://onco.cc/technologies/active-surveillance/), [IMRT / IGRT (modern external beam)](https://onco.cc/technologies/imrt-igrt/)
- terms: [Active surveillance and observation](https://onco.cc/terms/active-surveillance-term/), [Clinical complete response (cCR)](https://onco.cc/terms/clinical-complete-response/), [Cluster-randomised trial](https://onco.cc/terms/cluster-randomised-trial/), [Non-inferiority margin and equivalence trials](https://onco.cc/terms/non-inferiority-margin/), [Non-inferiority trial](https://onco.cc/terms/non-inferiority/), [Oesophagectomy](https://onco.cc/terms/oesophagectomy/), [Stepped-wedge design](https://onco.cc/terms/stepped-wedge-design/)
- trials: [CROSS](https://onco.cc/trials/cross/)
- people: [J. Jan B. van Lanschot](https://onco.cc/people/jan-van-lanschot/)
- pairings: [CROSS chemoradiation → surgery → adjuvant nivolumab if residual disease](https://onco.cc/pairings/cross-then-nivolumab/)
- ideas: [Organ preservation as the default after complete response in oesophageal cancer](https://onco.cc/ideas/idea-organ-preservation-esophageal/)
- bottlenecks: [Surgery and radiotherapy cure most, get least](https://onco.cc/bottlenecks/b-surgery-radiation-innovation/)
- roadmaps: [Surgery roadmap: radical operations → less surgery → no surgery when a drug has done the work](https://onco.cc/roadmaps/surgery-roadmap/)

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JSON: https://onco.cc/api/v1/entities/sano.json