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2013 ; 13
(3
): 381-90
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Predicting tumour response
#MMPMID24061161
Kyle SD
; Law WP
; Miles KA
Cancer Imaging
2013[Sep]; 13
(3
): 381-90
PMID24061161
show ga
Response prediction is an important emerging concept in oncologic imaging, with
tailored, individualized treatment regimens increasingly becoming the standard of
care. This review aims to define tumour response and illustrate the ways in which
imaging techniques can demonstrate tumour biological characteristics that provide
information on the likely benefit to be received by treatment. Two imaging
approaches are described: identification of therapeutic targets and depiction of
the treatment-resistant phenotype. The former approach is exemplified by the use
of radionuclide imaging to confirm target expression before radionuclide therapy
but with angiogenesis imaging and imaging correlates for genetic response
predictors also demonstrating potential utility. Techniques to assess the
treatment-resistant phenotype include demonstration of hypoperfusion with dynamic
contrast-enhanced computed tomography and magnetic resonance imaging (MRI),
depiction of necrosis with diffusion-weighted MRI, imaging of hypoxia and tumour
adaption to hypoxia, and 99mTc-MIBI imaging of P-glycoprotein mediated drug
resistance. To date, introduction of these techniques into clinical practice has
often been constrained by inadequate cross-validation of predictive criteria and
lack of verification against appropriate response end points such as survival.
With further refinement, imaging predictors of response could play an important
role in oncology, contributing to individualization of therapy based on the
specific tumour phenotype. This ability to predict tumour response will have
implications for improving efficacy of treatment, cost-effectiveness and omission
of futile therapy.
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