For locally advanced esophageal cancer (EC), neoadjuvant chemoradiotherapy (nCRT) for 5 weeks
followed by esophagectomy and lymphadenectomy, if necessary, is standard of care. It is
reported that the pathological complete response (pCR) rate after nCRT ranges from 16% to
43%, with a median of 26.5%. According to current clinical guidelines, patients who achieved
pCR still go for surgery even though those patients who achieved pCR may not benefit from
surgery. Besides, about 50% of EC patients may have post-operative complications including
pneumonia, anastomotic leakage, recurrent laryngeal nerve paralysis, which lead to low
health-related quality of life (HQoL).
The golden standard to test the pathological response is by pathological assessment of the
surgical specimen and thus after surgery. Theoretically, if pCR after nCRT can be predicted
accurately before surgery by advanced imaging techniques, patients could have a wait-and-see.
The wait-and-see procedure includes regular follow-up and salvage surgery if recurrence is
present. Therefore, molecular fluorescence endoscopy (FME) using near-infrared fluorescence
(NIRF) tracer bevacizumab-800CW targeting vascular endothelial growth factor combined with
high-definition white light (HD-WL) endoscopy is expected to be a promising technique to
monitor pCR and fill the gap.