Brezun Juliette, Aide Nicolas, Peroux Evelyne, Lamboley Jean-Laurent, Gutman Fabrice, Lussato David, Helissey Carole
Department of Medical Oncology and Clinical Research Unit, Military Hospital Bégin, 94160 Saint-Mandé, France.
INSERM ANTICIPE U1086, Caen University, 14000 Caen, France.
Diagnostics (Basel). 2024 Sep 23;14(18):2104. doi: 10.3390/diagnostics14182104.
The advent of immune checkpoint inhibitors (ICIs) has revolutionized the treatment paradigm of lung cancer, resulting in notable enhancements in patient survival. Nevertheless, evaluating treatment response in patients undergoing immunotherapy poses distinct challenges due to unconventional response patterns like pseudoprogressive disease (PPD), dissociated response (DR), and hyperprogressive disease (HPD). Conventional response criteria such as the RECIST 1.1 may not adequately address these complexities. To tackle this issue, novel response criteria such as the iRECIST and imRECIST have been proposed, enabling a more comprehensive assessment of treatment response by incorporating additional scans and considering the best overall response even after radiologic progressive disease evaluation. Additionally, [18F]FDG PET/CT imaging has emerged as a valuable modality for evaluating treatment response, with various metabolic response criteria such as the PERCIMT, imPERCIST, and iPERCIST developed to overcome the limitations of traditional criteria, particularly in detecting pseudoprogression. A multidisciplinary approach involving oncologists, radiologists, and nuclear medicine specialists is crucial for effectively navigating these complexities and enhancing patient outcomes in the era of immunotherapy for lung cancer. In this review, we delineate the key components of these guidelines, summarizing essential aspects for radiologists and nuclear medicine physicians. Furthermore, we provide insights into how imaging can guide the management of individual lung cancer patients in real-world multidisciplinary settings.
免疫检查点抑制剂（ICIs）的出现彻底改变了肺癌的治疗模式，显著提高了患者的生存率。然而，由于存在假性进展（PPD）、分离反应（DR）和超进展性疾病（HPD）等非常规反应模式，评估接受免疫治疗患者的治疗反应面临着独特的挑战。传统的反应标准，如RECIST 1.1，可能无法充分应对这些复杂性。为了解决这个问题，已经提出了诸如iRECIST和imRECIST等新的反应标准，通过纳入额外的扫描并考虑即使在影像学进展性疾病评估后最佳的总体反应，从而能够更全面地评估治疗反应。此外，[18F]FDG PET/CT成像已成为评估治疗反应的一种有价值的方式，已经制定了各种代谢反应标准，如PERCIMT、imPERCIST和iPERCIST，以克服传统标准的局限性，特别是在检测假性进展方面。在肺癌免疫治疗时代，肿瘤学家、放射科医生和核医学专家参与的多学科方法对于有效应对这些复杂性和改善患者预后至关重要。在本综述中，我们阐述了这些指南的关键组成部分，总结了对放射科医生和核医学医生至关重要的方面。此外，我们还深入探讨了影像学如何在实际的多学科环境中指导个体肺癌患者的管理。
