MRI for personalised treatment in oesophageal cancer

Patients with oesophageal cancer without metastases are currently treated with five weeks of chemotherapy and radiation followed by surgery. Postoperatively, no tumour is found by the pathologist in 29% of patients. In these patients, not performing surgery is considered. A good clinical selection of complete responders prior to surgery is essential, and this thesis examines the role can be in this for diffusion-weighted MRI (DW-MRI).

DW-MRI has a high sensitivity to the selection of patients with residual tumour after chemoradiation. In addition, DW-MRI resulted in a higher sensitivity than the (currently widely used) technique FDG-PET/CT. Previous studies also described a high chance of false negatives in endoscopies performed by a gastrointestinal-liver-doctor. This implies that patients with residual tumour may be incorrectly not operated on. Therefore, the additional value of DW-MRI in endoscopy/EUS after chemoradiation was examined which led to higher detection of patients with residual tumour.

In conclusion, a promising role for DW-MRI was found for selecting complete responders after chemoradiation, which contributes to the implementation of organ-saving treatment for patients with oesophageal cancer.