Booth Thomas C, Thompson Gerard, Bulbeck Helen, Boele Florien, Buckley Craig, Cardoso Jorge, Dos Santos Canas Liane, Jenkinson David, Ashkan Keyoumars, Kreindler Jack, Huskens Nicky, Luis Aysha, McBain Catherine, Mills Samantha J, Modat Marc, Morley Nick, Murphy Caroline, Ourselin Sebastian, Pennington Mark, Powell James, Summers David, Waldman Adam D, Watts Colin, Williams Matthew, Grant Robin, Jenkinson Michael D
School of Biomedical Engineering & Imaging Sciences, King's College London, London, United Kingdom.
Department of Neuroradiology, King's College Hospital NHS Foundation Trust, London, United Kingdom.
Front Oncol. 2021 Feb 9;11:620070. doi: 10.3389/fonc.2021.620070. eCollection 2021.
To summarise current evidence for the utility of interval imaging in monitoring disease in adult brain tumours, and to develop a position for future evidence gathering while incorporating the application of data science and health economics.
Experts in 'interval imaging' (imaging at pre-planned time-points to assess tumour status); data science; health economics, trial management of adult brain tumours, and patient representatives convened in London, UK. The current evidence on the use of interval imaging for monitoring brain tumours was reviewed. To improve the evidence that interval imaging has a role in disease management, we discussed specific themes of data science, health economics, statistical considerations, patient and carer perspectives, and multi-centre study design. Suggestions for future studies aimed at filling knowledge gaps were discussed.
Meningioma and glioma were identified as priorities for interval imaging utility analysis. The "monitoring biomarkers" most commonly used in adult brain tumour patients were standard structural MRI features. Interval imaging was commonly scheduled to provide reported imaging prior to planned, regular clinic visits. There is limited evidence relating interval imaging in the absence of clinical deterioration to management change that alters morbidity, mortality, quality of life, or resource use. Progression-free survival is confounded as an outcome measure when using structural MRI in glioma. Uncertainty from imaging causes distress for some patients and their caregivers, while for others it provides an important indicator of disease activity. Any study design that changes imaging regimens should consider the potential for influencing current or planned therapeutic trials, ensure that opportunity costs are measured, and capture indirect benefits and added value.
Evidence for the value, and therefore utility, of regular interval imaging is currently lacking. Ongoing collaborative efforts will improve trial design and generate the evidence to optimise monitoring imaging biomarkers in standard of care brain tumour management.
总结目前关于间隔期成像在监测成人大脑肿瘤疾病中的效用的证据，并在纳入数据科学和卫生经济学应用的同时，为未来的证据收集确定一个方向。
“间隔期成像”（在预先计划的时间点进行成像以评估肿瘤状态）、数据科学、卫生经济学、成人大脑肿瘤试验管理方面的专家以及患者代表在英国伦敦召开会议。对目前使用间隔期成像监测脑肿瘤的证据进行了综述。为了提高间隔期成像在疾病管理中发挥作用的证据，我们讨论了数据科学、卫生经济学、统计考量、患者及护理人员观点以及多中心研究设计等具体主题。讨论了旨在填补知识空白的未来研究建议。
脑膜瘤和神经胶质瘤被确定为间隔期成像效用分析的重点。成人大脑肿瘤患者最常用的“监测生物标志物”是标准结构MRI特征。间隔期成像通常安排在计划的定期门诊就诊之前提供报告成像。在没有临床恶化的情况下，间隔期成像与改变发病率、死亡率、生活质量或资源使用的管理变化之间的证据有限。在神经胶质瘤中使用结构MRI时，无进展生存期作为一项结果指标存在混淆。成像带来的不确定性给一些患者及其护理人员造成困扰，而对另一些人来说，它是疾病活动的重要指标。任何改变成像方案的研究设计都应考虑影响当前或计划中的治疗试验的可能性，确保衡量机会成本，并获取间接益处和附加值。
目前缺乏关于定期间隔期成像的价值及效用的证据。正在进行的合作努力将改进试验设计，并产生证据以优化护理标准脑肿瘤管理中的监测成像生物标志物。
