A reliable prediction of a pathologic complete response (pathCR) to chemoradiotherapy before surgery for esophageal cancer would enable investigators to study the feasibility and outcome of an organ-preserving strategy after chemoradiotherapy. So far no clinical parameters or diagnostic studies are able to accurately predict which patients will achieve a pathCR. The aim of this study was to determine whether subjective and quantitative assessment of baseline and postchemoradiation 18 F-FDG PET can improve the accuracy of predicting pathCR to preoperative chemoradiotherapy in esophageal cancer beyond clinical predictors. Methods: This retrospective study was approved by the institutional review board, and the need for written informed consent was waived. Clinical parameters along with subjective and quantitative parameters from baseline and postchemoradiation 18 F-FDG PET were derived from 217 esophageal adenocarcinoma patients who underwent chemoradiotherapy followed by surgery. The associations between these parameters and pathCR were studied in univariable and multivariable logistic regression analysis. Four prediction models were constructed and internally validated using bootstrapping to study the incremental predictive values of subjective assessment of 18 F-FDG PET, conventional quantitative metabolic features, and comprehensive 18 F-FDG PET texture/geometry features, respectively. The clinical benefit of 18 F-FDG PET was determined using decision-curve analysis. Results: A pathCR was found in 59 (27%) patients. A clinical prediction model (corrected c-index, 0.67) was improved by adding 18 F-FDG PET-based subjective assessment of response (corrected c-index, 0.72). This latter model was slightly improved by the addition of 1 conventional quantitative metabolic feature only (i.e., postchemoradiation total lesion glycolysis; corrected c-index, 0.73), and even more by subsequently adding 4 comprehensive 18 F-FDG PET texture/geometry features (corrected c-index, 0.77). However, at a decision threshold of 0.9 or higher, representing a clinically relevant predictive value for pathCR at which one may be willing to omit surgery, there was no clear incremental value. Conclusion: Subjective and quantitative assessment of 18 F-FDG PET provides statistical incremental value for predicting pathCR after preoperative chemoradiotherapy in esophageal cancer. However, the discriminatory improvement beyond clinical predictors does not translate into a clinically relevant benefit that could change decision making.

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Approximately half of the patients diagnosed with oesophageal cancer present with unresectable or metastatic disease. Treatment for these patients aims to control dysphagia and other cancer-related symptoms, improve quality of life and prolong survival. In the past 25 years, modestly improved outcomes have been achieved in the treatment of patients with inoperable non-metastatic cancer who are medically not fit for surgery or have unresectable, locally advanced disease. Concurrent chemoradiotherapy offers the best outcomes in these patients. In distant metastatic oesophageal cancer, several double-agent or triple-agent chemotherapy regimens have been established as first-line treatment options. In addition, long-term results of multiple large randomized phase III trials using additional targeted therapies have been published in the past few years, affecting contemporary clinical practice and future research directions. For the local treatment of malignant dysphagia, various treatment options have emerged, and self-expandable metal stent (SEMS) placement is currently the most widely applied method. Besides the continuous search for improved SEMS designs to minimize the risk of associated complications, efforts have been made to develop and evaluate the efficacy of antireflux stents and irradiation stents. This Review outlines the current evidence and ongoing trends in the different modern-day, multidisciplinary interventions for patients with unresectable or metastatic oesophageal cancer with an emphasis on key randomized trials.

Atherosclerotic calcification of the aorta and right postceliac arteries that supply the gastric tube is an independent risk factor for anastomotic leakage after esophagectomy.

This large population-based cohort study demonstrates an association between LNY and overall survival, indicating a therapeutic value of extended lymphadenectomy during esophagectomy. Therefore, an extended lymphadenectomy should be the standard of care after nCRT.

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Gastric cancer is the fifth most common malignancy in the world, with nearly one million new cases of gastric cancer diagnosed every year. 1 Curative treatment of gastric adenocarcinoma consists of partial or total resection of the stomach combined with lymphadenectomy. 2 Over the last years, multimodality treatment strategies such as neoadjuvant chemo(radio)therapy, perioperative chemotherapy and adjuvant chemotherapy have gained importance in the treatment of gastric cancer by improving the likelihood of a radical tumor resection, disease free survival and overall survival. 3-8 Unfortunately, the overall 5 year survival rate still remains poor (35-45%). 4,9 Accurate staging of gastric cancer allows for selection of the most appropriate therapy, minimizes unnecessary surgery and maximizes the likelihood of benefit from the selected treatment. After initial diagnosis by gastroscopy with tumor biopsy, diagnostic work-up can consist of endoscopic ultrasonography (EUS), computed tomography (CT) and 18 F-fluorodeoxyglucose positron emission tomography (18 F-FDG PET). However, these techniques all have their limitations. EUS is an invasive, highly operator-dependent technique and does not detect distant metastases. 10,11 CT exposes patients to ionizing radiation and has poor soft-tissue contrast. 18 F-FDG PET is impaired by the fact that not all gastric carcinomas are 18 F-FDG-avid (avidity ranging from 42-96%) and has a low spatial resolution. 12 Historically, the role of magnetic resonance imaging (MRI) in gastric cancer has been limited, since relatively long acquisition times and technical challenges of peristaltic motion and respiration artifacts resulted in poor imaging quality. 13,14 With the continuous technical improvements in MRI scanning, including fast imaging techniques, (respiratory) motion compensation techniques, use of anti peristaltic agents and the introduction of functional MRI

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