Abstract
Esophageal cancer is the eighth most common cancer worldwide but is the sixth most common cause of cancer death. Neoadjuvant therapy in patients with
resectable esophageal cancer (T2–4, N0/1) is associated with improved survival and is considered the standard of care.2–5 The optimal multimodality treatment
strategy in esophageal cancer is still unclear, although there is evidence that neoadjuvant chemoradiation (CRT) confers a survival benefit compared with chemotherapy alone.Even so, treatment benefit from multimodal therapy is not universal as only those patients with an objective clinical and/or pathological response seem to derive a survival advantage from this strategy.
The management of esophageal cancer is heavily dependent on accurate tumor staging to direct initial treatment strategy, and also on clinical response
assessment to direct the subsequent management in those treated with neoadjuvant therapy. Accurate treatment response assessment is fundamental to
improving clinical outcomes. Early response assessment would allow a switch in the therapeutic strategy in non-responders, while later assessment could
provide prognostic information to direct subsequent follow-up and management. As yet, there is no single imaging modality that can accurately assess response to neoadjuvant therapy in esophageal cancer. Conventional
investigative modalities, such as endoscopic ultrasound (EUS) and computed tomography (CT), lack accuracy in this setting. Similarly, newer imaging
techniques, such as magnetic resonance imaging (MRI) and positron emission tomography (PET), are associated with their own limitations. Thus, there is
an urgent clinical need to develop imaging techniques with the ultimate aim of improving their utility and predictive ability in treatment response assessment in
localized esophageal cancer. This review evaluates the role of the various imaging techniques in the assessment of response following neoadjuvant
therapy in esophageal cancer.
resectable esophageal cancer (T2–4, N0/1) is associated with improved survival and is considered the standard of care.2–5 The optimal multimodality treatment
strategy in esophageal cancer is still unclear, although there is evidence that neoadjuvant chemoradiation (CRT) confers a survival benefit compared with chemotherapy alone.Even so, treatment benefit from multimodal therapy is not universal as only those patients with an objective clinical and/or pathological response seem to derive a survival advantage from this strategy.
The management of esophageal cancer is heavily dependent on accurate tumor staging to direct initial treatment strategy, and also on clinical response
assessment to direct the subsequent management in those treated with neoadjuvant therapy. Accurate treatment response assessment is fundamental to
improving clinical outcomes. Early response assessment would allow a switch in the therapeutic strategy in non-responders, while later assessment could
provide prognostic information to direct subsequent follow-up and management. As yet, there is no single imaging modality that can accurately assess response to neoadjuvant therapy in esophageal cancer. Conventional
investigative modalities, such as endoscopic ultrasound (EUS) and computed tomography (CT), lack accuracy in this setting. Similarly, newer imaging
techniques, such as magnetic resonance imaging (MRI) and positron emission tomography (PET), are associated with their own limitations. Thus, there is
an urgent clinical need to develop imaging techniques with the ultimate aim of improving their utility and predictive ability in treatment response assessment in
localized esophageal cancer. This review evaluates the role of the various imaging techniques in the assessment of response following neoadjuvant
therapy in esophageal cancer.
| Original language | English |
|---|---|
| Pages (from-to) | 116–130 |
| Number of pages | 15 |
| Journal | Diseases of the Esophagus |
| Volume | 29 |
| Issue number | 2 |
| Early online date | 21 Jan 2015 |
| DOIs | |
| Publication status | Published - Feb 2016 |
