Functional techniques promise fast follow-up

Cancer is being tackled from a host of new directions. Traditional methods of curing and controlling malignancy through surgery, systemic chemotherapy, and radiotherapy are no longer the only story. The development of targeted drug therapies and innovative interventional procedures is expanding oncologists' armamentarium considerably. The era of individually tailored treatment plans may be just around the corner.

This multidirectional approach is visible already in the liver. Although surgery remains the best chance of eradicating either primary or secondary disease, minimally invasive methods are helping prolong survival in patients unsuited for hepatectomy or transplant (see page 11). The limited success of chemotherapy at combating liver cancer has also stimulated research into new types of drugs, such as antiangiogenic and/or anti-epidermal growth factor receptor agents. Trials of such agents, either alone or in combination with another novel or conventional chemotherapy drug, are under way.

"Right now, for liver cancer, there is no systemic drug you can give that will cure the patient. If someone has liver cancer, whether it is primary or secondary, they will die unless you do something much more aggressive than just give them a systemic drug," said Dr. Claude Sirlin, an assistant professor of radiology and a member of the Hematologic Malignancies Program at the University of California, San Diego.

Of course, just having a plethora of possible treatment options does not, in itself, lead to better patient outcomes. Clinicians need the knowledge and confidence to select the right tool. Equally important, if that initial decision turns out to be flawed, practitioners need the flexibility to modify their treatment plan accordingly.

If a change in direction needs to be made and an alternative regimen instituted, the faster this switch is enacted the better. Information on treatment response must therefore be delivered as rapidly as possible, perhaps within days.

"If I have to wait for six, eight, or 10 weeks to see if a lesion is becoming larger or smaller, then valuable time might be lost for a patient who is on the wrong treatment," said Dr. Enrique Lopez Hänninen, head of radiology and nuclear medicine at the Martin Luther Hospital in Berlin. "If you could see that the patient was not responding adequately, then you would switch therapy."

MORE THAN MORPHOLOGY

Imaging-led assessments of tumor response are typically based on the internationally accepted Response Evaluation Criteria in Solid Tumors (RECIST). This voluntary standard, set out in 2000, uses measurements of lesion diameter to decide whether a cancer is responding partially, progressively, or not at all to therapy.