Nina Niu Sanford, Assistant Professor at UT Southwestern Medical Center, shared a post on X by Udhayvir Grewal, Resident Physician at Ochsner LSU Health Shreveport, adding:
“Finally read SANO – Ph3 RCT showing with active surveillance, OS non-inferior and QOL better than surgery.
This is already higher level evidence than for rectal ca non-op (no RCT but now a SOC). Why such different bars for acceptance?
IMO non-op should be option if cCR in esophageal/GEJ too.
Quoting Udhayvir Grewal’s post:
“Much awaited- SANO trial published
(Phase 3, non-inferiority trial)
309 patients with esophageal cancer with complete response after neoadjuvant chemoradiation (EUS, biopsy, PET) 198 active surveillance, 111 standard surgery.
74% adenocarcinoma
Median follow-up 38 months
2-year OS for active surveillance (74%) was non-inferior to standard surgery (71%) after modified ITT analysis. Also non-inferior in ITT analysis (75% vs 70%).
OS similar in modified ITT analysis (HR 1·14, two-sided 95% CI 0·74–1·78) or ITT analysis (0·83, 0·53–1·31).
The frequency of postoperative complications and postoperative mortality similar.
Non-inferiority margin 15% too wide?
Do we need to work towards establishing standard organ preserving approaches in esophageal cancer?”
Authors: Berend J van der Wilk, Ben M Eyck, Bas P L Wijnhoven, Sjoerd M Lagarde, Camiel Rosman, Roelf Valkema, Edwin S van der Zaag, Ewout W Steyerberg, J Jan B van Lanschot et al.
