Composite metrics in response assessment—new hope in oesophageal cancer?

Oesophageal cancer is still associated with poor prognosis. The progress in systemic treatment, radiation therapy and surgery over the last decades has resulted in only moderate improvement of survival. Neoadjuvant chemoradiotherapy (CRT) has been shown to be associated with tumour response in 60–70% of patients (1), and with complete pathological response (CPR) in 25–30% of patients (2,3). Although it reportedly improves survival, there are several concerns about its routine use. Besides the treatment-related toxicity, the most important issue is lack of reliable predictive factors for pathological tumour and nodal response. In fact, in non-responders the neoadjuvant therapy is harmful, as it delays alternative, potentially effective treatment. Progression during the neoadjuvant therapy is not rare in this subset of patients.