Surveillance for esophageal cancer, particularly in the context of patients treated with neoadjuvant chemoradiotherapy (nCRT), is a critical area of research and clinical practice. Active surveillance is an approach where patients are closely monitored after nCRT instead of proceeding directly to surgery.
Surveillance for esophageal cancer, particularly in the context of patients treated with neoadjuvant chemoradiotherapy (nCRT), is a critical area of research and clinical practice. Active surveillance is an approach where patients are closely monitored after nCRT instead of proceeding directly to surgery. This strategy has been shown to be non-inferior to immediate surgery for select patients, but it comes with challenges, especially in identifying which patients are suitable for this approach.
The SANO trial analyzed 750 esophageal or junctional cancer patients treated with the CROSS regimen of nCRT. It found that only 37% achieved a complete clinical response (CCR) 12 weeks after treatment, and of those who entered active surveillance (198 patients), only 25% maintained sustained CCR over a median follow-up of 54 months. This highlights the limited success of achieving and maintaining full remission with active surveillance.
Key findings from the study include:
The study underscores the need for advanced biomarkers, such as radiomics, circulating tumor DNA (ctDNA), and FAPI PET-CT, to improve the prediction of treatment response and guide decisions about active surveillance versus surgery. This approach could help optimize treatment strategies and reduce unnecessary delays for high-risk patients.
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