Person:

Alessandrino, Francesco

The last 5 years have been marked by profound innovation in the targeted treatment of chronic lymphocytic leukemia (CLL) and indolent lymphomas. Using CLL as a case study, we present a timeline and overview of the current treatment landscape for the radiologist, including an overview of clinical and radiological features of CLL, discussion of the targeted agents themselves, and the role of imaging in response and toxicity assessment. The goal is to familiarize the radiologist with multiple Food and Drug Administration (FDA)-approved targeted agents used in this setting and associated adverse events which are commonly observed in this patient population.

Objective: To review the role of imaging in surveillance of gastrointestinal stromal tumor (GIST), in the setting of adjuvant, neoadjuvant or metastatic disease, and to propose practical guidelines for surveillance for various risk categories of GIST. Conclusion: Imaging plays an active role in surveillance of GIST. Current surveillance protocols per NCCN and ESMO depend on the resectability of the primary tumor and on the presence of metastatic disease.

Aim: To assess if CT texture analysis (TA) can serve as a biomarker of liver toxicity in patients with colorectal cancer treated with 5-fluorouracil (5-FU)-based chemotherapy. Materials and methods: In this IRB-approved, HIPAA-compliant retrospective study, patients with colorectal cancer treated with 5-FU-based regimens during 2008-2010 were identified from institutional electronic database. Total 43 patients (23 women; mean age 56 years) with normal baseline liver function tests (LFTs), availability of baseline (pre-chemotherapy) and first follow-up CT (median 1.7 months, interquartile range (IQR):1.5-2.5) performed during chemotherapy were included. Two single-slice ROI of right and left liver lobe were obtained on baseline and first follow-up CT for TA. Texture features (mean, entropy, kurtosis, skewness, mean of positive pixel, standard deviation (SD)) were extracted using a commercially available software (TexRAD; Feedback Medical Ltd, Cambridge, UK). Changes in texture parameters between baseline and follow-up CT were evaluated with Wilcoxon signed-rank test for patients with and without LFT elevation during chemotherapy. Results: Patients with LFT elevation (n=34;79%) showed significantly different mean, entropy and SD (p-values range: 0.01-0.05) between baseline and first follow-up CT. No significant changes in features were observed in patients without LFT elevation (n=9;21%). In 19 patients (56%), first follow-up CT was performed before elevation of LFTs was observed. Conclusions: This proof-of-concept study shows that there are early changes in liver texture on first follow-up CT in patients with LFT elevation during 5-FU-based chemotherapy for colorectal cancer. In more than 50% of cases, these changes occur before LFT elevation becomes evident on blood tests.