Imaging-based characterization of tumoral heterogeneity for personalized cancer treatment

Abstract

With personalized tumor therapy, understanding and addressing the heterogeneity of malignant tumors is becoming increasingly important. Heterogeneity can be found within one lesion (intralesional) and between several tumor lesions emerging from one primary tumor (interlesional). The heterogeneous tumor cells may show a different response to treatment due to their biology, which in turn influences the outcome of the affected patients and the choice of therapeutic agents. Therefore, both intra- and interlesional heterogeneity should be addressed at the diagnostic stage. While genetic and biological heterogeneity are important parameters in molecular tumor characterization and in histopathology, they are not yet addressed routinely in medical imaging. This article summarizes the recently established markers for tumor heterogeneity in imaging as well as heterogeneous/mixed response to therapy. Furthermore, a look at emerging markers is given. The ultimate goal of this overview is to provide comprehensive understanding of tumor heterogeneity and its implications for radiology and for communication with interdisciplinary teams in oncology.

Key points: 

• Tumor heterogeneity can be described within one lesion (intralesional) or between several lesions (interlesional).

• The heterogeneous biology of tumor cells can lead to a mixed therapeutic response and should be addressed in diagnostics and the therapeutic regime.

• Quantitative image diagnostics can be enhanced using AI, improved histopathological methods, and liquid profiling in the future.

Zusammenfassung

Im Rahmen der personalisierten Tumortherapie wird es immer bedeutender, die Heterogenität von bösartigen Tumoren zu verstehen und zu berücksichtigen. Diese kann innerhalb einer Läsion (intralesional) und zwischen mehreren Tumorläsionen auftreten, die aus einem primären Tumor hervorgehen (interlesional). Die heterogenen Tumorzellen können aufgrund ihrer Biologie unterschiedliche Reaktionen auf verschiedene Behandlungen zeigen, was wiederum das Outcome der betroffenen Patienten und die Wahl der Therapie beeinflusst. Daher sollten sowohl intra- als auch interlesionale Heterogenität in der Diagnostik berücksichtigt werden. Während genetische und biologische Heterogenität wichtige Parameter in der molekularen Tumorcharakterisierung und in der Histopathologie sind, werden sie in der medizinischen Bildgebung noch nicht routinemäßig berücksichtigt. Dieser Artikel fasst die etablierten Marker für Tumorheterogenität in der Bildgebung sowie für heterogenes/gemischtes Therapieansprechen zusammen. Darüber hinaus wird ein Ausblick über aufkommende Marker gegeben. Ziel dieser Übersichtsarbeit ist es, ein umfassendes Verständnis der Heterogenität von Tumoren und ihrer Auswirkungen auf die Radiologie und die interdisziplinäre Kommunikation in der Onkologie zu vermitteln.

Kernaussagen: 

• Tumorheterogenität kann innerhalb einer Läsion (intralesional) oder zwischen mehreren Läsionen (interlesional) beschrieben werden.

• Die heterogene Biologie von Tumorzellen kann zu einer gemischten therapeutischen Reaktion führen und sollte sowohl bei Diagnose als auch Therapie berücksichtigt werden.

• Die quantitative Bilddiagnostik kann in Zukunft durch den Einsatz von KI, verbesserten histopathologischen Methoden und Liquid Profiling ergänzt werden.

Zitierweise

• Haag F, Hertel A, Tharmaseelan H et al. Imaging-based characterization of tumoral heterogeneity for personalized cancer treatment. Fortschr Röntgenstr 2024; 196: 262 – 272

Key words

oncologic imaging - tumor heterogeneity - personalized oncology

Publication History

Received: 02 May 2023

Accepted: 16 August 2023

Article published online:
09 November 2023

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