Added value of MRI to endoscopic and endosonographic response assessment after neoadjuvant chemoradiotherapy in oesophageal cancer

• Published in: European radiology Vol. 30; no. 5; pp. 2425 - 2434
• Main Authors: Vollenbrock, Sophie E., van Dieren, Jolanda M., Voncken, Francine E. M., van Turenhout, Sietze T., Kodach, Liudmila L., Hartemink, Koen J., van Sandick, Johanna W., Aleman, Berthe M. P., Beets-Tan, Regina G. H., Bartels-Rutten, Annemarieke
• Format: Journal Article
• Language: English
• Published: Berlin/Heidelberg Springer Berlin Heidelberg 01.05.2020; Springer Nature B.V
• Subjects: Aged; Biopsy, Fine-Needle; Cancer; Chemoradiotherapy; Chemoradiotherapy - methods; Chemotherapy; Diagnostic Radiology; Diagnostic systems; Diffusion Magnetic Resonance Imaging - methods; Endoscopy; Endosonography - methods; Esophageal cancer; Esophageal Neoplasms - diagnosis; Esophageal Neoplasms - therapy; Esophagectomy; Esophagus; Female; Gastroscopy; Histopathology; Humans; Imaging; Internal Medicine; Interventional Radiology; Magnetic resonance imaging; Male; Medicine; Medicine & Public Health; Middle Aged; Neoadjuvant Therapy - methods; Neuroradiology; Oncology; Patients; Radiation therapy; Radiology; Surgery; Tumors; Ultrasonic imaging; Ultrasound; Magnetic resonance imaging; Oesophageal neoplasms; Gastroscopy
• ISSN: 0938-7994; 1432-1084
• DOI: 10.1007/s00330-019-06605-x

Objectives In order to select oesophageal cancer patients after neoadjuvant chemoradiotherapy (nCRT) for organ-preserving treatment instead of surgery, a high diagnostic accuracy is required. The aim of this study was to evaluate whether MRI had additional value to gastroscopy with biopsies and endosonographic ultrasound (EUS) with fine needle aspiration (FNA) for the detection of residual tumour after nCRT. Methods Twenty-two patients with oesophageal cancer eligible for nCRT followed by oesophagectomy were prospectively included. All patients underwent (T2- and diffusion-weighted) MRI and gastroscopy+EUS before and after nCRT. Histopathology after oesophagectomy was the reference standard with pathological complete response (pCR) defined as ypT0N0. Diagnostic performance regarding the detection of residual tumour was calculated for gastroscopic biopsies and for EUS-FNA without and with MRI. Results Nineteen of the 22 patients (86%) did not achieve pCR after nCRT (7 ypT+N+, 11 ypT+N0, 1 ypT0N+). Biopsies detected residual tumour in 6 of 18 ypT+ patients. After adding MRI, 16 of 18 residual tumours were assessed correctly. EUS-FNA detected 3 out of 8 ypN+ patients, while MRI did not improve detection. Overall, adding MRI improved sensitivity for detection of residual tumour to 89% (17 of 19) from 47% (9 of 19) with endoscopic biopsies and EUS-FNA only. Conclusion In this small study, the detection of residual tumour after nCRT in oesophageal cancer patients was improved by the addition of MRI to gastroscopy and EUS. Key Points • In this small study, the detection of residual tumour after neoadjuvant chemoradiotherapy in oesophageal cancer patients was improved by adding MRI including diffusion-weighted images to gastroscopy and endosonographic ultrasound. • With the addition of MRI assessment to gastroscopy and endosonographic ultrasound, the considerable risk of missing residual tumours decreased from 53 to 11%, while the pitfall was overstaging in one out of three complete responders.