The value of DWI for predicting pathologic response to neoadjuvant immunotherapy combined with chemotherapy in locally advanced resectable ESCC

Motivation: Neoadjuvant immunotherapy (nIT) combined with standard chemotherapy is the innovative treatment for esophageal squamous cell carcinoma (ESCC). Some patients may not respond to nIT. Goal(s): To investigate the value of DWI-derived parameters for the assessment of pathologic response and detection of minimal residual cancer cell (MRC) to nIT. Approach: The patient population was a sub-cohort from the clinical trial (ClinicalTrials.gov ID: NCT02611700). The pathological response evaluation according to the TRG system proposed by AJCC. DWI-derived parameters including ADC, D, D* and f. Results: ΔADC and ΔD values were highlighting in assessment of pathologic response and detection of MRC to nIT. Impact: Nowadays, evaluation of the response to neoadjuvant therapy for cancer mainly relies on the measurement of tumor size according to RECIST. Pseudo-progression with immunotherapy is often observed. fMRI techniques can quantify therapy-induced changes before anatomic variation in tumor size.