PET-guided treatment algorithms in oesophageal cancer: the promise of the near future!

Although the implementation of neoadjuvant multimodality strategies resulted in pathologic downstaging, improvement of resection rates and a decrease in recurrent disease, 5-year survival rates of oesophageal carcinoma are still below 50% (1). The most common reason for treatment failure is the development of distant metastases, also after trimodality therapy, consisting of chemoradiotherapy followed by oesophagectomy. This means that the patient must have been harboured micrometastases during the neoadjuvant chemoradiotherapy already. In order to destroy these micrometastases, additional induction chemotherapy before trimodality therapy has been investigated all over the world. It is not completely clear whether the addition of induction therapy results in a survival benefit (2-5).