Radiological Monitoring of the Treatment of Solid Tumors in Practice

Abstract

!Purpose: Thanks to advances in cancer therapy, the diagnosis of "incurable cancer" is increasingly able to be changed to a chronic disease that is manageable over long periods, resulting in a change in the clinical management of cancer patients with solid tumors. New parameters are needed to measure the success of targeted therapy in clinical trials. Materials and Methods: Review article on the basis of selective literature research. Results: In order to assess how well solid tumors respond to treatment, size-based criteria called RECIST (Response Evaluation Criteria in Solid tumors) have been defined. These criteria have been validated in large oncology trials and are currently used most frequently. New molecular therapies often do not -or at least do not immediately -reduce the size of a tumor. Therefore, RECIST evaluation should be critically assessed especially in the case of modern therapies. Any additional available tumor biology information should be considered. In radiology new methods and developments of RECIST have been introduced to better assess the success of targeted therapy. Conclusion: Assessment according to RECIST has been proven for the follow-up of classic tumor therapy. For the monitoring of targeted therapies, new parameters are often required. Therefore, some specific tumor-and therapy-adapted criteria have already been defined to better evaluate treatment success in clinical trials. Key points:▶ Follow-up evaluation of treatment is becoming increasingly important in modern oncology.▶ Conventional cytostatic/cytotoxic treatments can be evaluated on the basis of size according to RECIST. ▶ However, approx. 80 % of newly approved oncological agents are based on molecular mechanisms of action.

Pragmatic medicine in solid cancer: a translational alternative to precision medicine

“…For too long, drug approval in solid cancer has been based on the RECIST convention, namely, tumor shrinkage 45 , 46 ( Figure 2 ). This is the case despite the near-universal recognition that the tumor shrinkage end point is a relic of the cytotoxic era and far from a precision end point.…”

Responsekriterien bei malignem Melanom

“…So führt Ipilimumab® als molekularer anti-CTLA-4-Antikörper zu einer Immunreaktion durch Aktivierung von T-Zellen mit assoziierter Migration von Lymphozyten und Makrophagen in das Tumorgewebe. In manchen Fällen resultiert dies in einen messbaren Pseudoprogress oder in einer radiologisch erstmaligen Detektion vormals okkulter Tumorläsionen [6,11]. CR "complete response", PR "partial response", PD "progressive disease", SD "stable disease".…”

Malignant Pediatric Bone Tumors - Treatment & Management

“…Anatomic and functional imaging is utilized to assist with treatment response. However, with the availability of newer agents that target immunological, antiangiogenic, antihormonal, and antimetabolic pathways, methods of assessing effi cacy of treatments are being reevaluated (Ganten et al 2014 ). A summary of differences between WHO and RECIST criteria is described below (Table 13.1 ).…”

“…More recently, RECIST has been modifi ed to take functional biological information into consideration (Ganten et al 2014 ). The PERCIST (PET Response Criteria in Solid Tumors) was proposed in 2009 and takes into account biological information from PET imaging, especially in those patients treated with newer therapies, during response evaluation.…”