Post Treatment Cancer Imaging

Dr. Anshul Varshney

SR Radiodiagnosis
Introduction
• Daily practice and research in oncology are shifting toward precision
medicine, with treatments targeted to specific patient and tumor
profiles.
• This underlying concept of health care enables to personalize chemo-
therapy (ChT) and radiotherapy (RT) schemes improving safety and
effectiveness.
Oncology imaging
• Meanwhile, advancements in oncology imaging walk hand-in-hand
with new treatment strategies.
• Fast and highly performing CT and MRI technologies have opened
new frontiers in oncology imaging, allowing tissue characterization,
early diagnosis, prognostic evaluation, and accurate response
assessment.
• This innovative approach results in shifting the radiological
assessment from the mere morphologic evaluation to obtaining
qualitative and functional data that can be combined with patients
clinical information.
• Nevertheless, oncology treatment regimens may lead to local and
systemic changes and complications depending on the type of
treatment.
• In this scenario, the correct interpretation of post-treatment imaging
exams
is crucial for an adequate and prompt management of cancer
patients.
• Indeed, expected changes of normal tissues with specific imaging
features are associated with several treatments.
Aim of today’s class
• Here, we discuss the main imaging changes induced by different
treatment strategies in a comprehensive assessment “from head to
toe.”
• The primary aim of this presentation is to guide in the interpretation
of post-treatment imaging exams for an adequate differentiation of
expected post-treatment changes from pathological findings.
CNS
Central nervous system (CNS)
• CNS toxicity of anticancer treatments has received growing interest
over the last years, as severe neurotoxicity may affect up to 33% of
patients.
• It may occur after partial or whole-brain RT and ChT, due to a direct or
an indirect injury (e.g., coagulopathy).
• MRI is the modality of choice to differentiate therapy-related side
effects from disease progression, infections, and paraneoplastic syn-
dromes.
Pseudo-progression
True progression
Radionecrosis vs Tumor recurrence –Importance of rCBV
LUNGS
R-ILI RADIATION INDUCED
LUNG INJURY