How often does mid-treatment imaging change how cancers are managed?
Imaging might not drive as many treatment adjustments as previously believed, according to a new meta-analysis.
Imaging exams are routinely used alongside neoadjuvant systemic therapy (NST) for breast cancer to assess how patients are responding to treatment. Any changes identified can be used to guide providers in managing treatment plans and, therefore, outcomes. Although the use of imaging to monitor treatment efficacy is seen as a significant benefit, a new analysis suggests that providers may not always be swayed by what they see in patients’ scans.
“While prediction of pathological complete response (pCR) from imaging has been widely studied, it remains unclear whether imaging findings during treatment are actually used to guide therapeutic decisions in clinical practice,” Pascal A.T. Baltzer, with the division of general and pediatric radiology at the Medical University of Vienna in Austria, and colleagues write in the European Journal of Radiology. “The extent to which clinical trials implement imaging-based response monitoring as a tool for treatment modification is not well-established.”
To get a better idea of how imaging findings are used in treatment management, Baltzer and colleagues conducted a meta-analysis that incorporated five clinical practice guidelines and 147 clinical trial publications involving NST for breast cancer. The team examined which modalities were most often utilized, when the scans took place amid treatment regimens, response criteria and if/how treatments changed after imaging results were shared.
Imaging was utilized in the majority (81%) of the studies, with little over half of the trials (56%) deploying mid-treatment imaging. Ultrasound, MRI and mammography were the most frequently used modalities, though some researchers opted for PET studies.
Despite the high mid-treatment utilization observed, just 15% of those studies reported implementing treatment modifications based on imaging response. What’s more, the team also took note of a lack of standardized imaging protocols or consistent response-guided treatment strategies, as the methods varied widely among the trials.
This lack of standardization in these protocols limits the benefits of using imaging as a treatment barometer, the group suggests. They propose the development of treatment algorithms for guiding treatment modifications based on imaging responses as one possible solution.
“Otherwise treatment monitoring by imaging does provide only limited value and could be restricted to pretherapeutic and posttherapeutic staging to determine tumor extent and surgical margins,” they advise. “These efforts are essential for tapping into the potential of imaging to guide personalized treatment to escalate or de-escalate treatment to improve clinical outcomes.”
Learn more about the findings here.
In addition to her background in journalism, Hannah also has patient-facing experience in clinical settings, having spent more than 12 years working as a registered rad tech. She began covering the medical imaging industry for Innovate Healthcare in 2021.