Active follow-up after chemoradiotherapy for thoracic esophageal cancer: a comparative analysis of patients with clinical complete response (cCR) managed without surgery and patients with pathological complete response (pCR) after esophagectomy

Abstract

Background: chemoradiotherapy followed by esophagectomy is one of the standard treatment options for locally advanced thoracic esophageal cancer. However, the patient management during active follow-up is attracting increasing interest as a personalized treatment approach for selected patients who achieve a clinical complete response (cCR) after chemoradiotherapy. Aim: to compare outcomes in patients with cCR in whom surgery was not performed for various reasons with outcomes in patients who achieved a pathological complete response (pCR, ypT0N0) after esophageal resection. Materials and Methods: a multicenter retrospective cohort study was conducted. The initial database included 409 patients with thoracic esophageal cancer. Of these, 66 patients were included in the final subanalysis: 36 patients in the active surveillance group and 30 patients in the pCR group. All patients received concurrent chemoradiotherapy according to the CROSS protocol or radiotherapy with the FOLFOX regimen. After completion of chemoradiotherapy, all patients underwent comprehensive assessment to evaluate treatment response. The primary endpoints were overall survival and event-free survival. Results: no statistically significant differences in overall survival were found between the groups (log-rank p=0.83; HR 1.08; 95% CI 0.53– 2.19). Differences in event-free survival also did not reach statistical significance (p=0.14; HR 1.64; 95% CI 0.85–3.17), although the active surveillance group showed a trend toward an earlier decline in the survival curves. Analysis of disease recurrence demonstrated that distant and combined patterns of progression predominated in both groups. Conclusion: in patients with cCR after chemoradiotherapy who were managed with active surveillance, overall survival and event-free survival were comparable to those observed in patients with pCR after esophagectomy (p=0.83 and p=0.14, respectively). KEYWORDS: esophageal cancer, chemoradiotherapy, active surveillance, clinical complete response, pathological complete response, esophagectomy. FOR CITATION: Toneev E.A., Dengina N.V., Pikin O.V., Slugin A.E., Rudenko M.S., Kiselev N.M., Gamayunov S.V., Torgomyan G.G., Abdrakhmanova A.M. Active follow-up after chemoradiotherapy for thoracic esophageal cancer: a comparative analysis of patients with clinical complete response (cCR) managed without surgery and patients with pathological complete response (pCR) after esophagectomy. Russian Medical Inquiry. 2026;10(7):458–464 (in Russ.). DOI: 10.32364/2587-6821-2026-10-7-1