Radiological Evaluation of the Therapeutic Response of Malignant Diseases: Status Quo, Innovative Developments and Requirements for Radiology

Abstract

In consequence of the rapid development of newer targeted and personalized tumor therapies, radiology as an essential component of the treatment concept of numerous malignant diseases needs to improve in order to adequately capture and evaluate the effects, but also the side effects of these novel therapeutic agents. The early recognition of therapy response or failure is crucial for the optimal planning of the further treatment and can therefore have direct impact on the chances of recovery and the survival time of oncological patients. In previous years, the goal of medical imaging was to just qualitatively assess the increase or reduction in the size of tumors and their metastases, which was often achieved by a simple subjective estimation of the tumor findings by the diagnosing radiologist. Nowadays, radiology is faced with the challenge of evaluating changes during therapy quantitatively and of visualizing therapeutic effects that are more discrete (e. g. necrosis, altered tumor perfusion). The importance of an adequate assessment of therapy response is further underlined by the fact that in these days, a good portion of oncological patients are enrolled in clinical trials, in which the quantitative radiological evaluation of malignant disorders is an important surrogate parameter. On the basis of this development, the demands for radiology to provide more sophisticated assessments of therapy response and documentation of imaging findings have been constantly growing. The following article provides an overview of the established and still widely spread but in particular also the latest imaging modalities and evaluation criteria with regard to oncological diseases as well as of the increasing demands on radiology that result from these developments. Beyond that, future advancements in tumor imaging are taken into account and the new challenges these developments will bring are discussed.

Key points:

• In the era of personalized medicine, evaluation criteria that are individually adapted to the respective patient are required.

• Radiology needs to substantially contribute to oncological treatment concepts and the evaluation of therapeutic response.

Citation Format:

• Höink AJ, Heindel W, Buerke B. Radiological Evaluation of the Therapeutic Response of Malignant Diseases: Status Quo, Innovative Developments and Requirements for Radiology. Fortschr Röntgenstr 2014; 186: 927 – 936

Zusammenfassung

Bedingt durch die rasante Entwicklung immer neuer, zielgerichteter und personalisierter Tumortherapeutika ist auch die Radiologie als wesentlicher Bestandteil im Behandlungskonzept zahlreicher maligner Erkrankungen gefordert, sich ständig weiterzuentwickeln, um die Effekte, aber auch die Nebenwirkungen dieser neuartigen Therapeutika adäquat erfassen und bewerten zu können. Die frühzeitige Erkennung eines Therapieansprechens oder -versagens ist essenziell für die optimale Planung der weiteren Behandlung und kann damit unmittelbare Auswirkungen auf die Heilungschancen und die Überlebenszeit onkologischer Patienten haben. Bestand die Aufgabe der Bildgebung in früheren Jahren im Wesentlichen darin, ein Größenwachstum oder eine -abnahme von Tumoren und deren Metastasen rein qualitativ zu erfassen, was vielfach durch die einfache subjektive Abschätzung des Tumorbefundes durch den Radiologen erfolgte, so steht sie nun vor der Herausforderung, Änderungen unter Therapie quantitativ zu erfassen und auch diskretere Therapieeffekte (wie z. B. Nekrosen oder eine veränderte Tumorperfusion) zu visualisieren. Die adäquate Beurteilung des Therapieansprechens gewinnt zusätzlich durch die Tatsache an Bedeutung, dass ein Großteil der onkologischen Patienten heutzutage in klinische Studien eingeschlossen ist, für die die quantitative radiologische Bewertung maligner Erkrankungen einen wichtigen Surrogatparameter darstellt. Auf Basis dieser Entwicklung sind in den letzten Jahren die Forderungen an die Radiologie hinsichtlich einer immer aufwändigeren Auswertung des Therapieansprechens und der Befunddokumentation ständig gewachsen. Im Folgenden soll ein Überblick sowohl über die etablierten und nach wie vor weit verbreiteten, insbesondere aber über die neuesten bildgebenden Methoden und Bewertungskriterien onkologischer Erkrankungen gegeben werden. Darüber hinaus werden zukünftige Entwicklungen in der bildgebenden Tumordiagnostik in den Fokus genommen und es wird diskutiert, welche neuen Herausforderungen diese Entwicklungen für die Radiologie mit sich bringen.

Key words

biological effects - PET-CT - treatment effects - MR imaging - CT - segmentation

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