Esophageal Cancer: Active Monitoring May Rival Immediate Surgery After Chemoradiation
Table of Contents
- Esophageal Cancer: Active Monitoring May Rival Immediate Surgery After Chemoradiation
- Esophageal Cancer: Active Monitoring vs. Immediate Surgery – What You Need to Know
- WhatS the main takeaway from the new study about esophageal cancer treatment?
- What is esophageal cancer and what is chemoradiation?
- How does active monitoring work in esophageal cancer treatment?
- Who might be a good candidate for active monitoring after chemoradiation?
- what did the Dutch study, cited in the article, investigate?
- What were the methods of the Dutch study (SANO trial)?
- what were the key findings of this study?
- What are the implications of these findings for patients and doctors?
- Does this mean everyone with esophageal cancer can skip surgery?
- What are the limitations of the study?
- Where can I find more facts about this study?
for some esophageal cancer patients who respond exceptionally well too neoadjuvant chemoradiation therapy, active monitoring might potentially be a viable alternative to immediate surgery, according to a new study.
Study Suggests Active surveillance is Non-Inferior
A significant number of individuals diagnosed with esophageal cancer exhibit such a strong response to neoadjuvant chemoradiation that the tumor becomes undetectable. This “pathological response” opens the door for active surveillance, a strategy were surgery is only performed if the disease progresses. A study published in Lancet Oncology indicates that this approach is not inferior to immediate surgery in terms of survival rates.
Details of the Dutch Study
The phase 3 study, conducted across multiple hospitals in the Netherlands, involved 309 participants (men and women) aged 18 and older. All participants’ tumors had initially disappeared following neoadjuvant chemoradiation and were no longer detectable through imaging. Of the participants, 111 underwent immediate surgery after the therapy, while 198 were placed under active surveillance, with surgery performed only upon disease progression.
Key Findings: Survival Rates and Side Effects
after a two-year observation period, researchers found that the active monitoring strategy was not inferior to immediate surgery. There was no statistically significant difference in overall survival between the two groups. Furthermore, the rate of side effects following immediate or delayed surgery showed no significant differences.
Long-Term Monitoring Still Needed
The study group concluded that active monitoring was not inferior to immediate surgery in the first two years for esophageal cancer patients who responded fully to neoadjuvant chemoradiation. However, they emphasized the need for continued observation to assess the long-term effects of both active monitoring and immediate surgery.
The study authors are:
van der Wilk BJ et al.Neoadjuvant chemoradiotherapy followed by active surveillance versus standard surgery for oesophageal cancer (SANO trial): a multicentre, stepped-wedge, cluster-randomised, non-inferiority, phase 3 trial. Lancet Oncology, Onlinevorabveröffentlichung am 17. März 2025, DOI: 10.1016/S1470-2045(25)00027-0
Esophageal Cancer: Active Monitoring vs. Immediate Surgery – What You Need to Know
WhatS the main takeaway from the new study about esophageal cancer treatment?
According to a recent study, for some esophageal cancer patients who have a great response to neoadjuvant chemoradiation therapy, active monitoring may be a comparable alternative to immediate surgery. This means that instead of promptly removing the esophagus (the tube that carries food to the stomach), doctors might choose to closely watch the patient and only perform surgery if the cancer reappears or progresses.
What is esophageal cancer and what is chemoradiation?
According to the source material, “Esophageal cancer” is not directly defined, therefore I must address from a third-party source.
Esophageal cancer is a type of cancer that occurs in the esophagus, the long tube that carries food and liquids from your throat to your stomach. Chemoradiation is a combination of chemotherapy (drugs that kill cancer cells) and radiation therapy, which uses high-energy rays to target and destroy cancer cells. Neoadjuvant chemoradiation is given before surgery to shrink the tumor and make the surgery easier.
How does active monitoring work in esophageal cancer treatment?
active monitoring,or active surveillance,involves closely watching a patient for signs of cancer progression after neoadjuvant chemoradiation. This usually includes regular imaging tests (like CT scans or PET scans) and/or other tests to check for any recurrence of the cancer. Surgery is only performed if the disease shows signs of coming back or growing.
Who might be a good candidate for active monitoring after chemoradiation?
The study focuses on patients who have a “pathological response” – a strong response where the tumor is no longer detectable through imaging after neoadjuvant chemoradiation. This means the cancer has seemingly disappeared, opening the door for active monitoring as a potential alternative to immediate surgery.
what did the Dutch study, cited in the article, investigate?
The Dutch study, published in Lancet Oncology, investigated whether active monitoring was as effective as immediate surgery for esophageal cancer patients who responded well to neoadjuvant chemoradiation. The study, a phase 3 trial, compared the survival rates and side effects of both approaches.
What were the methods of the Dutch study (SANO trial)?
The study was a phase 3 trial conducted across numerous hospitals in the netherlands.It involved 309 participants, both men and women aged 18 and older. These persons were deemed to have tumors that initially cleared up following chemoradiation and were no longer evident via imaging. The participants were split into two groups:
- Immediate Surgery Group: 111 participants underwent immediate surgery following chemoradiation.
- Active Surveillance Group: 198 participants were placed under active surveillance. Surgery was only performed if the cancer progressed.
what were the key findings of this study?
After a two-year observation period, researchers found that active monitoring was not inferior to immediate surgery. This means it was just as effective, as ther was no statistically significant difference in overall survival rates between the two groups. Also, the rate of side effects from both immediate and delayed surgery did not differ considerably.
Summarizing Key Findings
Here’s a table summarizing the key findings of the study:
| Factor | Active Monitoring | Immediate Surgery |
|---|---|---|
| Overall Survival (2-year) | Comparable | Comparable |
| Side Effects | No significant difference | No significant difference |
| Patient Group | Patients with tumors that became undetectable after chemoradiation | Patients with tumors that became undetectable after chemoradiation |
What are the implications of these findings for patients and doctors?
The study suggests that active monitoring could be a viable alternative to immediate surgery for certain esophageal cancer patients who respond remarkably well to chemoradiation.This could potentially spare some patients the immediate risks and side effects of surgery, offering a less invasive approach.
Does this mean everyone with esophageal cancer can skip surgery?
No. The study’s findings apply only to those patients who have a complete response to neoadjuvant chemoradiation—meaning their tumors disappear or become undetectable. Also, the study only assessed results for the first two years, showing no disadvantage in that timescale. Patients and doctors must carefully consider the individual’s specific situation, the cancer’s characteristics, and other health factors when making treatment decisions. The research does not support a worldwide change in treatment protocols; it suggests a potential option for some patients.
What are the limitations of the study?
The study authors emphasize the need for continued observation to assess the long-term effects of both active monitoring and immediate surgery. Two years is still a limited time frame to evaluate treatment outcomes, meaning the long-term effects need to be observed to draw conclusions.
Where can I find more facts about this study?
The complete study, “Neoadjuvant chemoradiotherapy followed by active surveillance versus standard surgery for oesophageal cancer (SANO trial): a multicentre, stepped-wedge, cluster-randomised, non-inferiority, phase 3 trial,” authored by van der wilk BJ et al., was published in Lancet Oncology. the DOI is available in the citation provided. Please ask your medical providers for additional info.
