Organ preservation in esophageal cancer treatment, is it time now?

Table 1 Comparison of major clinical trials in esophageal cancer

Ref.	Study	Sample size	Histology composition	Neoadjuvant therapy	pCR rate	Key findings
Allum et al[40], 2009	OEO2	802	72% ESCC, 28% EAC	2 cycles (cisplatin + 5-FU)	NR	Improved OS (HR = 0.82) with chemo vs surgery alone
van Hagen et al[41], 2012	CROSS	368	75% ESCC, 25% EAC	5 cycles (carboplatin + paclitaxel) + RT (41.4 Gy)	23% (EAC); 49% (ESCC)	CRT improved OS (HR = 0.657) vs surgery
Yang et al[42], 2018	NEOCRTEC5010	451	100% ESCC	2 cycles (vinorelbine/cisplatin) + RT (40 Gy)	43.2%	nCRT significantly improved pCR
Bedenne et al[43], 2007	FFCD9102	259	88.8% ESCC, 11.2% EAC	2 cycles (cisplatin/5-FU) + CRT (46 Gy)	NR	CRT alone (non-surgical) had similar OS as CRT vs surgery
Qian et al[47], 2022		256	100% ESCC	4 cycles (docetaxel + cisplatin) + RT (40 Gy)	48.1%	dCRT vs nCRT → surgery for cCR patients; similar OS, supporting organ preservation in responders
van der Wilk et al[48], 2025	SANO	309	22.7% ESCC, 74.8% EAC	5 cycles (carboplatin + paclitaxel) + RT (41.4 Gy)	NR	Active surveillance feasible for cCR patients with low relapse risk
Yang et al[50], 2025	preSINO	309	100% ESCC	5 cycles (carboplatin + paclitaxel) + RT (41.4 Gy)	NR	Combining EUS-FNA and ctDNA improved residual disease detection sensitivity

NR: Not reported; pCR: Pathological complete response; ESCC: Esophageal squamous cell carcinoma; EAC: Esophageal adenocarcinoma; OS: Overall survival; HR: Hazard ratio; CRT: Chemotherapy, chemoradiotherapy; cCR: Clinical complete response; EUS-FNA: Endoscopic ultrasound-guided fine-needle aspiration; dCRT: Definitive chemoradiotherapy; nCRT: Neoadjuvant chemoradiotherapy; RT: Radiotherapy.