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

  • Oncology
  • Published:
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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.

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Abbreviations

cCR:

Clinical complete response

CI:

Confidence interval

CLS:

Confidence level score

EUS:

Endosonographic ultrasound

FNA:

Fine needle aspiration

IQR:

Interquartile range

nCRT:

Neoadjuvant chemoradiotherapy

pCR:

Pathological complete response

ROC:

Receiver operator characteristic

SAE:

Serious adverse event

TRG:

Tumour regression grade

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Funding

The authors state that this work has not received any funding.

Author information

Authors and Affiliations

  1. Department of Radiology, The Netherlands Cancer Institute, Antoni van Leeuwenhoek, Plesmanlaan 121, 1066, CX, Amsterdam, The Netherlands

    Sophie E. Vollenbrock, Regina G. H. Beets-Tan & Annemarieke Bartels-Rutten

  2. GROW School for Oncology and Developmental Biology, Maastricht University, Maastricht, The Netherlands

    Sophie E. Vollenbrock & Regina G. H. Beets-Tan

  3. Department of Gastrointestinal Oncology, The Netherlands Cancer Institute, Antoni van Leeuwenhoek, Amsterdam, The Netherlands

    Jolanda M. van Dieren & Sietze T. van Turenhout

  4. Department of Radiation Oncology, The Netherlands Cancer Institute, Antoni van Leeuwenhoek, Amsterdam, The Netherlands

    Francine E. M. Voncken & Berthe M. P. Aleman

  5. Department of Pathology, The Netherlands Cancer Institute, Antoni van Leeuwenhoek, Amsterdam, The Netherlands

    Liudmila L. Kodach

  6. Department of Surgical Oncology, The Netherlands Cancer Institute, Antoni van Leeuwenhoek, Amsterdam, The Netherlands

    Koen J. Hartemink & Johanna W. van Sandick

Authors
  1. Sophie E. Vollenbrock
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  2. Jolanda M. van Dieren
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  3. Francine E. M. Voncken
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  6. Koen J. Hartemink
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  7. Johanna W. van Sandick
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  8. Berthe M. P. Aleman
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Corresponding author

Correspondence to Sophie E. Vollenbrock.

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Guarantor

The scientific guarantor of this publication is A. Bartels-Rutten.

Conflict of interest

The authors of this manuscript declare no relationships with any companies whose products or services may be related to the subject matter of the article.

Statistics and biometry

No complex statistical methods were necessary for this paper.

Informed consent

Written informed consent was obtained from all patients in this study.

Ethical approval

Institutional Review Board approval was obtained.

Study subjects or cohorts overlap

The data on MRI assessment of twelve patients included in this study were previously used in a study focusing on response assessment on MRI only [19]. All 22 patients included in the current study underwent both gastroscopy+EUS and MRI and the combination of these modalities was evaluated.

Methodology

• Prospective

• Diagnostic or prognostic study

• Performed at one institution

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Electronic supplementary material

ESM 1

Supplementary Table 1. MRI sequence parameters. Supplementary Figure 1. Confidence level score (DOCX 77 kb)

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Vollenbrock, S.E., van Dieren, J.M., Voncken, F.E.M. et al. Added value of MRI to endoscopic and endosonographic response assessment after neoadjuvant chemoradiotherapy in oesophageal cancer. Eur Radiol 30, 2425–2434 (2020). https://doi.org/10.1007/s00330-019-06605-x

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