ideasIdea
Organ preservation as the default after complete response in oesophageal cancer
Oesophagectomy is one of the hardest operations in surgery. If chemoradiation (with or without immunotherapy) has made the tumour disappear, skip it and watch.
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.
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.
What would test it
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