Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

At a glance: The STEP trials

A round-up of the STEP phase 3 clinical trials evaluating semaglutide for weight loss in people with overweight or obesity.
ADVANCED SEARCH
Log in
Top
European Radiology
Published in: European Radiology 5/2020

01-05-2020 | Magnetic Resonance Imaging | Oncology

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

Authors: Sophie E. Vollenbrock, Jolanda M. van Dieren, Francine E. M. Voncken, Sietze T. van Turenhout, Liudmila L. Kodach, Koen J. Hartemink, Johanna W. van Sandick, Berthe M. P. Aleman, Regina G. H. Beets-Tan, Annemarieke Bartels-Rutten

Published in: European Radiology | Issue 5/2020

Login to get access

Abstract

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.
Appendix
Available only for authorised users
Literature
1.
Bray F, Ferlay J, Soerjomataram I, Siegel RL, Torre LA, Jemal A (2018) Global cancer statistics 2018: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin 68:394–424CrossRef
2.
van Hagen P, Hulshof MC, van Lanschot JJ et al (2012) Preoperative chemoradiotherapy for esophageal or junctional cancer. N Engl J Med 366:2074–2084CrossRef
3.
4.
5.
Noordman BJ, Wijnhoven BPL, Lagarde SM et al (2018) Neoadjuvant chemoradiotherapy plus surgery versus active surveillance for oesophageal cancer: a stepped-wedge cluster randomised trial. BMC Cancer 18:142CrossRef
6.
Noordman BJ, Spaander MCW, Valkema R et al (2018) Detection of residual disease after neoadjuvant chemoradiotherapy for oesophageal cancer (preSANO): a prospective multicentre, diagnostic cohort study. Lancet Oncol 19:965–974CrossRef
7.
Castoro C, Scarpa M, Cagol M et al (2013) Complete clinical response after neoadjuvant chemoradiotherapy for squamous cell cancer of the thoracic oesophagus: is surgery always necessary? J Gastrointest Surg 17:1375–1381CrossRef
8.
Furlong H, Bass G, Breathnach O, O’Neill B, Leen E, Walsh TN (2013) Targeting therapy for esophageal cancer in patients aged 70 and over. J Geriatr Oncol 4:107–113CrossRef
9.
Ohkura Y, Shindoh J, Ueno M, Iizuka T, Udagawa H (2018) Comparison of outcome of esophagectomy versus nonsurgical treatment for resectable esophageal cancer with clinical complete response to neoadjuvant therapy. Ann Surg Oncol 25:2428–2433CrossRef
10.
Findlay JM, Gillies RS, Franklin JM et al (2016) Restaging oesophageal cancer after neoadjuvant therapy with (18)F-FDG PET-CT: identifying interval metastases and predicting incurable disease at surgery. Eur Radiol 26:3519–3533CrossRef
11.
Kroese TE, Goense L, van Hillegersberg R et al (2018) Detection of distant interval metastases after neoadjuvant therapy for esophageal cancer with 18F-FDG PET(/CT): a systematic review and meta-analysis. Dis Esophagus 31
12.
Foley KG, Hills RK, Berthon B et al (2018) Development and validation of a prognostic model incorporating texture analysis derived from standardised segmentation of PET in patients with oesophageal cancer. Eur Radiol 28:428–436CrossRef
13.
de Gouw D, Klarenbeek BR, Driessen M et al (2019) Detecting pathological complete response in esophageal cancer after neoadjuvant therapy based on imaging techniques: a diagnostic systematic review and meta-analysis. J Thorac Oncol 14:1156–1171CrossRef
14.
15.
Maas M, Lambregts DM, Nelemans PJ et al (2015) Assessment of clinical complete response after chemoradiation for rectal cancer with digital rectal examination, endoscopy, and MRI: selection for organ-saving treatment. Ann Surg Oncol 22:3873–3880CrossRef
16.
van der Valk MJM, Hilling DE, Bastiaannet E et al (2018) Long-term outcomes of clinical complete responders after neoadjuvant treatment for rectal cancer in the International Watch & Wait Database (IWWD): an international multicentre registry study. Lancet 391:2537–2545CrossRef
17.
Yip C, Cook GJ, Landau DB, Davies A, Goh V (2016) Performance of different imaging modalities in assessment of response to neoadjuvant therapy in primary esophageal cancer. Dis Esophagus 29:116–130CrossRef
18.
Yamada I, Miyasaka N, Hikishima K et al (2015) Ultra-high-resolution MR imaging of esophageal carcinoma at ultra-high field strength (7.0T) ex vivo: correlation with histopathologic findings. Magn Reson Imaging 33:413–419CrossRef
19.
Vollenbrock SE, Voncken FEM, van Dieren JM et al (2019) Diagnostic performance of MRI for assessment of response to neoadjuvant chemoradiotherapy in oesophageal cancer. Br J Surg 106:596–605CrossRef
20.
Lever FM, Lips IM, Crijns SP et al (2014) Quantification of esophageal tumor motion on cine-magnetic resonance imaging. Int J Radiat Oncol Biol Phys 88:419–424CrossRef
21.
Lambregts DM, Vandecaveye V, Barbaro B et al (2011) Diffusion-weighted MRI for selection of complete responders after chemoradiation for locally advanced rectal cancer: a multicenter study. Ann Surg Oncol 18:2224–2231CrossRef
22.
Rice TW, Blackstone EH, Rusch VW (2010) 7th edition of the AJCC Cancer Staging Manual: esophagus and esophagogastric junction. Ann Surg Oncol 17:1721–1724CrossRef
23.
Mandard AM, Dalibard F, Mandard JC et al (1994) Pathologic assessment of tumor regression after preoperative chemoradiotherapy of esophageal carcinoma. Clinicopathologic correlations. Cancer 73:2680–2686
24.
Heneghan HM, Donohoe C, Elliot J et al (2016) Can CT-PET and endoscopic assessment post-neoadjuvant chemoradiotherapy predict residual disease in esophageal cancer? Ann Surg 264:831–838CrossRef
25.
Cheedella NK, Suzuki A, Xiao L et al (2013) Association between clinical complete response and pathological complete response after preoperative chemoradiation in patients with gastroesophageal cancer: analysis in a large cohort. Ann Oncol 24:1262–1266CrossRef
26.
Kitajima K, Nakajo M, Kaida H et al (2017) Present and future roles of FDG-PET/CT imaging in the management of gastrointestinal cancer: an update. Nagoya J Med Sci 79:527–543PubMedPubMedCentral
27.
van Rossum PS, van Lier AL, van Vulpen M et al (2015) Diffusion-weighted magnetic resonance imaging for the prediction of pathologic response to neoadjuvant chemoradiotherapy in esophageal cancer. Radiother Oncol 115:163–170CrossRef
28.
Shapiro J, ten Kate FJ, van Hagen P, Biermann K, Wijnhoven BP, van Lanschot JJ (2013) Residual esophageal cancer after neoadjuvant chemoradiotherapy frequently involves the mucosa and submucosa. Ann Surg 258:678–688 discussion 688–689CrossRef
29.
van der Bogt RD, Noordman BJ, Krishnadath KK et al (2019) Endoscopic ultrasound measurements for detection of residual disease after neoadjuvant chemoradiotherapy for esophageal cancer. Endoscopy 51:326–332CrossRef
30.
Griffin JM, Reed CE, Denlinger CE (2012) Utility of restaging endoscopic ultrasound after neoadjuvant therapy for esophageal cancer. Ann Thorac Surg 93:1855–1859 discussion 1860CrossRef
31.
Eloubeidi MA, Cerfolio RJ, Bryant AS, Varadarajulu S (2011) Efficacy of endoscopic ultrasound in patients with esophageal cancer predicted to have N0 disease. Eur J Cardiothorac Surg 40:636–641PubMed
32.
33.
Qu J, Shen C, Qin J et al (2019) The MR radiomic signature can predict preoperative lymph node metastasis in patients with esophageal cancer. Eur Radiol 29:906–914CrossRef
34.
Tan X, Ma Z, Yan L, Ye W, Liu Z, Liang C (2019) Radiomics nomogram outperforms size criteria in discriminating lymph node metastasis in resectable esophageal squamous cell carcinoma. Eur Radiol 29:392–400CrossRef
Metadata
Title
Added value of MRI to endoscopic and endosonographic response assessment after neoadjuvant chemoradiotherapy in oesophageal cancer
Authors
Sophie E. Vollenbrock
Jolanda M. van Dieren
Francine E. M. Voncken
Sietze T. van Turenhout
Liudmila L. Kodach
Koen J. Hartemink
Johanna W. van Sandick
Berthe M. P. Aleman
Regina G. H. Beets-Tan
Annemarieke Bartels-Rutten
Publication date
01-05-2020
Publisher
Springer Berlin Heidelberg
Published in
European Radiology / Issue 5/2020
Print ISSN: 0938-7994
Electronic ISSN: 1432-1084
DOI
https://doi.org/10.1007/s00330-019-06605-x

Other articles of this Issue 5/2020

European Radiology 5/2020 Go to the issue

Hepatobiliary-Pancreas

LI-RADS treatment response categorization on gadoxetic acid-enhanced MRI: diagnostic performance compared to mRECIST and added value of ancillary features

Gastrointestinal

Value of combined multiparametric MRI and FDG-PET/CT to identify well-responding rectal cancer patients before the start of neoadjuvant chemoradiation

Chest

Stratification of long-term outcome in stable idiopathic pulmonary fibrosis by combining longitudinal computed tomography and forced vital capacity

Imaging Informatics and Artificial Intelligence

Differentiation of supratentorial single brain metastasis and glioblastoma by using peri-enhancing oedema region–derived radiomic features and multiple classifiers

Interventional

Minimal ablative margin (MAM) assessment with image fusion: an independent predictor for local tumor progression in hepatocellular carcinoma after stereotactic radiofrequency ablation

Magnetic Resonance

MRI of non-specific low back pain and/or lumbar radiculopathy: do we need T1 when using a sagittal T2-weighted Dixon sequence?