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Published on: February 17, 2023
Emerging methods for disease monitoring in malignant gliomas
Prakash Ambady1, Chetan Bettegowda, Matthias Holdhoff
1Brain Cancer Program, The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, 1550 Orleans Street, 1M16, Baltimore, MD 21287, USA.
Abstract:
MRI remains the backbone of measuring disease burden and treatment response in individuals with malignant gliomas. Traditional radiographic approaches, however, are largely limited to depicting anatomic changes and are not a direct measure of disease burden. For example, contrast enhancement is related to blood-brain barrier integrity rather than actual tumor size. Without accurate measures of disease, common clinical dilemmas include 'pseudo-progression' (e.g., after chemoradiation) or 'pseudo-response' (e.g., with steroid treatment and antiangiogenic agents), which can lead to delays in therapy, premature discontinuation of successful treatments and to unnecessary surgical procedures. This overview focuses on novel, minimally invasive approaches in the area of imaging and blood-based biomarkers that aim to more accurately determine disease status and response to treatment in malignant brain tumors.
Insights
Accurate measurement of malignant glioma burden is challenging with traditional MRI. Novel imaging and blood biomarkers offer improved methods for assessing disease status and treatment response in brain tumors.
Area of Science:
- Neuro-oncology
- Medical Imaging
- Biomarker Discovery
Background:
- Magnetic Resonance Imaging (MRI) is standard for tracking malignant glioma progression and treatment efficacy.
- Traditional MRI methods primarily show anatomical changes, not direct disease burden, leading to misinterpretations like pseudo-progression or pseudo-response.
- These diagnostic challenges can result in suboptimal patient management, including treatment delays, premature cessation of effective therapies, and unnecessary surgeries.
Purpose of the Study:
- To review novel, minimally invasive imaging and blood-based biomarker approaches for enhanced accuracy in assessing malignant brain tumor status.
- To address the limitations of conventional MRI in differentiating true tumor changes from treatment effects.
- To provide insights into advanced techniques for more precise disease burden and treatment response evaluation.
Main Methods:
- Review of current literature on advanced imaging techniques for brain tumors.
- Exploration of emerging blood-based biomarkers for neuro-oncology.
- Analysis of the diagnostic capabilities of novel approaches compared to traditional MRI.
Main Results:
- Novel imaging techniques and blood biomarkers show promise in more accurately reflecting true disease burden and treatment response in malignant gliomas.
- These advanced methods can help differentiate actual tumor progression from treatment-related changes, such as pseudo-progression and pseudo-response.
- Minimally invasive approaches offer a more direct measure of tumor biology and therapeutic effect.
Conclusions:
- Advanced imaging and blood biomarkers represent a significant step forward in the accurate assessment of malignant brain tumors.
- These innovative tools have the potential to improve clinical decision-making, optimize treatment strategies, and enhance patient outcomes.
- Further research and clinical validation are essential to fully integrate these novel approaches into routine neuro-oncology practice.
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