Neoadjuvant Imaging Methods in Esophageal Cancer Therapy

Neoadjuvant imaging in oesophageal cancer integrates anatomical and functional modalities to predict treatment response, guide patient selection and tailor multimodal therapy. Conventional computed tomography provides high‐resolution assessment of tumour size and morphology, while positron emission tomography (PET) with fluorodeoxyglucose ([18F]FDG) quantifies metabolic activity. Hybrid PET/MRI adds soft-tissue contrast and simultaneous diffusion‐weighted imaging, capturing cellular density changes via apparent diffusion coefficient (ADC) mapping. Dynamic contrast-enhanced MRI (DCE-MRI) assesses microvascular perfusion through transfer constants and area-under-curve metrics. Recent advances in radiomics have enabled extraction of quantitative features such as tumour compactness from routine imaging, yielding prognostic models that often outperform standard staging. Combined approaches have demonstrated improved accuracy for predicting pathological complete response, long-term survival and nodal involvement, thereby informing the decision to proceed with surgery, intensify therapy or consider organ-preserving strategies.

Research from Nature Portfolio

A risk model based on computed tomography–derived tumour compactness has been developed and validated across three independent cohorts of squamous cell carcinoma. By quantifying volume and surface area to calculate compactness, the model stratified patients into high- and low-risk groups for overall and progression-free survival. In low-risk patients, the survival benefit of concurrent chemoradiotherapy was attenuated, supporting personalised treatment intensification or de-escalation.

Quantitative and semi-quantitative parameters derived from dynamic contrast-enhanced MRI have been shown to distinguish oesophageal squamous cell carcinoma and lymphatic metastases from normal tissue. Higher endothelial transfer constant and reflux rate, coupled with shorter time-to-peak, reliably identified primary tumours (area-under-curve >0.9) and predicted nodal involvement. The combined use of these perfusion metrics offers a non-invasive biomarker suite for staging and monitoring neoadjuvant therapy response.

Neoadjuvant Imaging Methods in Esophageal Cancer Therapy publication trend

The graph below shows the total number of articles in neoadjuvant imaging methods in esophageal cancer therapy across all publications each year (not limited to Nature Index journals).

Technical terms

Neoadjuvant therapy: Treatment given before the main intervention (usually surgery) to reduce tumour burden and improve outcomes.

[18F]FDG-PET: A nuclear medicine scan using fluorodeoxyglucose to measure tumour glucose metabolism.

Diffusion-weighted MRI (DW-MRI): An MRI technique sensitive to the motion of water molecules, used to infer cellular density via ADC values.

Apparent diffusion coefficient (ADC): A quantitative measure of water diffusion within tissue; lower ADC often indicates higher cellularity.

Dynamic contrast-enhanced MRI (DCE-MRI): Imaging method that tracks the passage of contrast agent over time to assess tissue perfusion and permeability.

Total lesion glycolysis (TLG): A PET metric combining lesion volume and mean standardized uptake value to reflect metabolic tumour burden.

Tumour compactness: A radiomic feature calculated from CT volume and surface area, indicating the shape regularity and density of a lesion.

Transfer constant (Ktrans): A DCE-MRI parameter representing the rate at which contrast moves from plasma into the extracellular extravascular space.

References

1. Baseline and interim [18F]FDG-PET/MRI to assess treatment response and survival in patients with M0 esophageal squamous cell carcinoma treated by curative-intent therapy. Cancer Imaging (2023).
2. Preoperative image-guided identification of response to neoadjuvant chemoradiotherapy in esophageal cancer (PRIDE): a multicenter observational study. BMC Cancer (2018).
3. Diffusion-weighted MRI and 18F-FDG PET/CT in assessing the response to neoadjuvant chemoradiotherapy in locally advanced esophageal squamous cell carcinoma. Radiation Oncology (2021).
4. Tumor Compactness based on CT to predict prognosis after multimodal treatment for esophageal squamous cell carcinoma. Scientific Reports (2019).
5. Assessing Microcirculation in Resectable Oesophageal Squamous Cell Carcinoma with Dynamic Contrast-enhanced MRI for Identifying Primary tumour and Lymphatic Metastasis. Scientific Reports (2019).