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In oesophageal cancer (OC) neo‐adjuvant chemoradiotherapy (neoCRT) is used to debulk tumour size prior to surgery, with a complete pathological response (pCR) observed in approximately ∼30% of patients. Presently no predictive quantitative methodology exists which can predict response, in particular a pCR or major response (MR), in patients prior to therapy. Raman and Fourier transform infrared imaging were performed on OC tissue specimens acquired from 50 patients prior to therapy, to develop a computational model linking spectral data to treatment outcome. Modelling sensitivities and specificities above 85% were achieved using this approach. Parallel in‐vitro studies using an isogenic model of radioresistant OC supplied further insight into OC cell spectral response to ionising radiation where a potential spectral biomarker of radioresistance was observed at 977 cm−1. This work demonstrates that chemical imaging may provide an option for triage of patients prior to neoCRT treatment allowing more precise prescription of treatment.

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