MR-Guided Radiotherapy in Oesophageal Cancer: From Principles to Practice-A Narrative Review

Fong, SC; Lau, E; Liu, DS; Tebbutt, NC; Khor, R; Leong, T; Williams, D; Uribe, S; Ng, SP

Author(s): Fong, SC; Lau, E; Liu, DS; Tebbutt, NC; Khor, R; Leong, T; Williams, D; Uribe, S; Ng, SP;
Details: Publication Year 2026-01-08,Volume 33,Issue #1,Page 34
Journal Title: Current Oncology
Publication Type: Review
Abstract: Oesophageal cancer remains a significant global health burden with poor survival outcomes despite multimodal treatment. Recent advances in magnetic resonance imaging (MRI) have opened opportunities to improve radiotherapy delivery. This review examines the role of MRI and MR-guided radiotherapy (MRgRT) in oesophageal cancer, focusing on applications in staging, treatment planning, and response assessment, with particular emphasis on magnetic resonance linear accelerator (MR-Linac)-based delivery. Compared to computed tomography (CT), MRI offers superior soft-tissue contrast, enabling more accurate tumour delineation and the potential for reduced treatment margins. Real-time MR imaging during treatment can facilitate motion management, while daily adaptive planning can accommodate anatomical changes throughout the treatment course. Functional MRI sequences, including diffusion-weighted and dynamic contrast-enhanced imaging, offer quantitative data for treatment response monitoring. Early clinical and dosimetric studies demonstrate that MRgRT can significantly reduce radiation dose to critical organs while maintaining target coverage. However, clinical evidence for MRgRT in oesophageal cancer is limited to small early-phase studies, with no phase II/III trials demonstrating improvements in survival, toxicity, or patient-reported outcomes. Long-term clinical benefits and cost-effectiveness remain unproven, highlighting the need for prospective outcome-focused studies to define the role for MRgRT within multimodality treatment pathways.
Publisher: MDPI
Keywords: Humans; *Esophageal Neoplasms/radiotherapy/diagnostic imaging/pathology; *Radiotherapy, Image-Guided/methods; *Magnetic Resonance Imaging/methods; Radiotherapy Planning, Computer-Assisted/methods; MR-Linac; MR-guided radiotherapy; adaptive radiotherapy; diffusion-weighted imaging; functional MRI; motion management; oesophageal cancer; personalised radiotherapy; tumour delineation
Department(s): Radiation Oncology; Surgical Oncology
Publisher's Version: https://doi.org/10.3390/curroncol33010034
Open Access at Publisher's Site: https://doi.org/10.3390/curroncol33010034
Terms of Use/Rights Notice: Refer to copyright notice on published article.

Creation Date: 2026-02-03 06:11:41

Last Modified: 2026-02-03 06:11:50