Performance of different imaging modalities in assessment of response to neo-adjuvant therapy in primary esophageal cancer
C.Yip et al. Dis Esophagus February 2016
Although neo-adjuvant therapies (NT) are widely employed in the treatment of esophageal cancer, a substantial benefit in survival is evident only for those patients with an objective clinical and/or pathological response. The accurate assessment of response is therefore a paramount to optimize the treatment of such patients. The diagnostic tools to assess the response following neo-adjuvant therapy are far by optimal, however, and no single imaging modality has a sufficient diagnostic accuracy.
In their excellent review (C. Yip and coworkers examine the currently available imaging modalities: endoscopic ultrasound (EUS), computed tomography (CT), positron emission tomography associated to CT scan (PET-CT scan) and functional MRI. Each of the first three imaging modality have shown relevant limitations in assessing response to NT. The authors suggest that functional MRI with gadolinium is the single imaging modality that provides excellent soft tissue delineation and functional information regarding tumor angiogenesis, having the potential to be a useful response-assessment tool (if confirmed by further studies). In addition its combination with PET (PET/functional MRI) could be the way forward in the response assessment after NT in esophageal cancer.
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