Toufic Kachaamy, Chief of Medicine and Director of Gastroenterology at City of Hope, shared a post on LinkedIn:
“Organ Preservation in Esophageal and GE Junction Cancer: Are We Ready for Prime Time?
Compelling data presented at ASCO GI highlight a growing shift toward organ-preserving strategies in selected patients with esophageal and gastroesophageal junction adenocarcinoma who achieve a clinical complete response (cCR) after chemoradiation.
Key takeaways:
- Chemoradiation can induce durable cCR, allowing some patients to remain locally disease-free without immediate surgery.
- Active surveillance (AS) with rigorous endoscopic, biopsy, and imaging follow-up—can safely defer esophagectomy and reserve surgery for those who truly need it.
- Important point for my fellow Endodvopoc oncologists: Bite-on-bite biopsies significantly improve detection of residual disease, with low complication rates.
- Long-term outcomes show no clear overall survival disadvantage for AS compared with immediate surgery in carefully selected patients.
- Importantly, patient preferences matter: when quality of life is included in decision-making, many patients favor surveillance over upfront surgery.
While local regrowth is common, the majority of patients remain eligible for successful salvage surgery, and operative morbidity and mortality appear comparable to standard approaches.
What’s next?
Can we impact local recurrence with Cryotherapy?
This is not about doing less it’s about doing what matters most for the right patient at the right time.”
More posts featuring Toufic Kachaamy.