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Castagnoli F, Mencel J, Ap Dafydd D, Gough J, Drake B, Mcaddy NC, Withey SJ, Riddell AM, Koh DM, Shur JD. Response Evaluation Criteria in Gastrointestinal and Abdominal Cancers: Which to Use and How to Measure. Radiographics 2024; 44:e230047. [PMID: 38662587 DOI: 10.1148/rg.230047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/29/2024]
Abstract
As the management of gastrointestinal malignancy has evolved, tumor response assessment has expanded from size-based assessments to those that include tumor enhancement, in addition to functional data such as those derived from PET and diffusion-weighted imaging. Accurate interpretation of tumor response therefore requires knowledge of imaging modalities used in gastrointestinal malignancy, anticancer therapies, and tumor biology. Targeted therapies such as immunotherapy pose additional considerations due to unique imaging response patterns and drug toxicity; as a consequence, immunotherapy response criteria have been developed. Some gastrointestinal malignancies require assessment with tumor-specific criteria when assessing response, often to guide clinical management (such as watchful waiting in rectal cancer or suitability for surgery in pancreatic cancer). Moreover, anatomic measurements can underestimate therapeutic response when applied to molecular-targeted therapies or locoregional therapies in hypervascular malignancies such as hepatocellular carcinoma. In these cases, responding tumors may exhibit morphologic changes including cystic degeneration, necrosis, and hemorrhage, often without significant reduction in size. Awareness of pitfalls when interpreting gastrointestinal tumor response is required to correctly interpret response assessment imaging and guide appropriate oncologic management. Data-driven image analyses such as radiomics have been investigated in a variety of gastrointestinal tumors, such as identifying those more likely to respond to therapy or recur, with the aim of delivering precision medicine. Multimedia-enhanced radiology reports can facilitate communication of gastrointestinal tumor response by automatically embedding response categories, key data, and representative images. ©RSNA, 2024 Test Your Knowledge questions for this article are available in the supplemental material.
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Affiliation(s)
- Francesca Castagnoli
- From the Departments of Radiology (F.C., D.a.D., N.C.M., S.J.W., A.M.R., D.M.K., J.D.S.), Oncology (J.M.), Radiotherapy (J.G.), and Nuclear Medicine (B.D.), Royal Marsden Hospital, Downs Road, Sutton SM2 5PT, UK; and Division of Radiotherapy and Imaging, The Institute of Cancer Research, London, UK (F.C., D.M.K.)
| | - Justin Mencel
- From the Departments of Radiology (F.C., D.a.D., N.C.M., S.J.W., A.M.R., D.M.K., J.D.S.), Oncology (J.M.), Radiotherapy (J.G.), and Nuclear Medicine (B.D.), Royal Marsden Hospital, Downs Road, Sutton SM2 5PT, UK; and Division of Radiotherapy and Imaging, The Institute of Cancer Research, London, UK (F.C., D.M.K.)
| | - Derfel Ap Dafydd
- From the Departments of Radiology (F.C., D.a.D., N.C.M., S.J.W., A.M.R., D.M.K., J.D.S.), Oncology (J.M.), Radiotherapy (J.G.), and Nuclear Medicine (B.D.), Royal Marsden Hospital, Downs Road, Sutton SM2 5PT, UK; and Division of Radiotherapy and Imaging, The Institute of Cancer Research, London, UK (F.C., D.M.K.)
| | - Jessica Gough
- From the Departments of Radiology (F.C., D.a.D., N.C.M., S.J.W., A.M.R., D.M.K., J.D.S.), Oncology (J.M.), Radiotherapy (J.G.), and Nuclear Medicine (B.D.), Royal Marsden Hospital, Downs Road, Sutton SM2 5PT, UK; and Division of Radiotherapy and Imaging, The Institute of Cancer Research, London, UK (F.C., D.M.K.)
| | - Brent Drake
- From the Departments of Radiology (F.C., D.a.D., N.C.M., S.J.W., A.M.R., D.M.K., J.D.S.), Oncology (J.M.), Radiotherapy (J.G.), and Nuclear Medicine (B.D.), Royal Marsden Hospital, Downs Road, Sutton SM2 5PT, UK; and Division of Radiotherapy and Imaging, The Institute of Cancer Research, London, UK (F.C., D.M.K.)
| | - Naami Charlotte Mcaddy
- From the Departments of Radiology (F.C., D.a.D., N.C.M., S.J.W., A.M.R., D.M.K., J.D.S.), Oncology (J.M.), Radiotherapy (J.G.), and Nuclear Medicine (B.D.), Royal Marsden Hospital, Downs Road, Sutton SM2 5PT, UK; and Division of Radiotherapy and Imaging, The Institute of Cancer Research, London, UK (F.C., D.M.K.)
| | - Samuel Joseph Withey
- From the Departments of Radiology (F.C., D.a.D., N.C.M., S.J.W., A.M.R., D.M.K., J.D.S.), Oncology (J.M.), Radiotherapy (J.G.), and Nuclear Medicine (B.D.), Royal Marsden Hospital, Downs Road, Sutton SM2 5PT, UK; and Division of Radiotherapy and Imaging, The Institute of Cancer Research, London, UK (F.C., D.M.K.)
| | - Angela Mary Riddell
- From the Departments of Radiology (F.C., D.a.D., N.C.M., S.J.W., A.M.R., D.M.K., J.D.S.), Oncology (J.M.), Radiotherapy (J.G.), and Nuclear Medicine (B.D.), Royal Marsden Hospital, Downs Road, Sutton SM2 5PT, UK; and Division of Radiotherapy and Imaging, The Institute of Cancer Research, London, UK (F.C., D.M.K.)
| | - Dow-Mu Koh
- From the Departments of Radiology (F.C., D.a.D., N.C.M., S.J.W., A.M.R., D.M.K., J.D.S.), Oncology (J.M.), Radiotherapy (J.G.), and Nuclear Medicine (B.D.), Royal Marsden Hospital, Downs Road, Sutton SM2 5PT, UK; and Division of Radiotherapy and Imaging, The Institute of Cancer Research, London, UK (F.C., D.M.K.)
| | - Joshua David Shur
- From the Departments of Radiology (F.C., D.a.D., N.C.M., S.J.W., A.M.R., D.M.K., J.D.S.), Oncology (J.M.), Radiotherapy (J.G.), and Nuclear Medicine (B.D.), Royal Marsden Hospital, Downs Road, Sutton SM2 5PT, UK; and Division of Radiotherapy and Imaging, The Institute of Cancer Research, London, UK (F.C., D.M.K.)
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Greenwood H, Hassan J, Fife K, Ajithkumar TV, Thippu Jayaprakash K. Single-Fraction Stereotactic Ablative Body Radiotherapy for Primary and Extracranial Oligometastatic Cancers. Clin Oncol (R Coll Radiol) 2023; 35:773-786. [PMID: 37852814 DOI: 10.1016/j.clon.2023.10.049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2023] [Revised: 09/14/2023] [Accepted: 10/04/2023] [Indexed: 10/20/2023]
Abstract
Stereotactic ablative body radiotherapy (SABR) consists of delivering high doses of ionising radiation, typically across three to eight fractions with high precision and conformity. SABR has become increasingly commonplace throughout the last quarter of a century and is offered for the treatment of various primary and metastatic tumour types. Delivering SABR in a single fraction has arisen as an appealing possibility for several reasons. These include fewer hospital visits, greater patient convenience, improved sustainability and lower costs. However, these factors must be balanced against considerations such as toxicity, side-effects and, most importantly, progression-free and overall survival. In this review we seek to analyse the results of studies looking at the efficacy of single-fraction SABR for lung, prostate, renal and pancreas primary tumours, as well as oligometastases. The tumour type to be most widely treated with single-fraction SABR is lung, but its remit continues to expand. We also look at the biological rationale underpinning SABR and how this can be extended to single-fraction regimens. Finally, we turn our attention towards the future directions of SABR and specifically single-fraction regimens. These include the possibility of combining SABR with immunotherapy and technological advances in the field, which could serve to expand the scope of SABR. We conclude by summarising the current clinical studies of single-fraction SABR.
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Affiliation(s)
- H Greenwood
- School of Clinical Medicine, University of Cambridge, Cambridge, UK
| | - J Hassan
- University College London Medical School, London, UK
| | - K Fife
- Oncology Centre, Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - T V Ajithkumar
- Oncology Centre, Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - K Thippu Jayaprakash
- Oncology Centre, Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK; Department of Oncology, The Queen Elizabeth Hospital King's Lynn NHS Foundation Trust, King's Lynn, UK.
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