Designing
novel systems for efficient cancer treatment and improving
the quality of life for patients is a prime requirement in the healthcare
sector. In this regard, theranostics have recently emerged as a unique
platform, which combines the benefits of both diagnosis and therapeutics
delivery. Theranostics have the desired contrast agent and the drugs
combined in a single carrier, thus providing the opportunity for real-time
imaging to monitor the therapy results. This helps in reducing the
hazards related to treatment overdose or underdose and gives the possibility
of personalized therapy. Polysaccharides, as natural biomolecules,
have been widely explored to develop theranostics, as they act as
a matrix for simultaneously loading both contrast agents and drugs
for their utility in drug delivery and imaging. Additionally, their
remarkable physicochemical attributes (biodegradability, satisfactory
safety profile, abundance, and diversity in functionality and charge)
can be tuned via postmodification, which offers numerous possibilities
to develop theranostics with desired characteristics. Hence, we provide
an overview of recent advances in polysaccharide matrix-based theranostics
for drug delivery combined with magnetic resonance imaging, computed
tomography, positron emission tomography, single photon emission computed
tomography, and ultrasound imaging. Herein, we also summarize the
toxicity assessment of polysaccharides, associated contrast agents,
and nanotoxicity along with the challenges and future research directions.