1. To understand the basic principle of immune related therapies.
2. To learn how tumour morphology and functional parameters change with therapy.
3. To appreciate the existing evidence for immune therapy follow-up strategies.
The immune system is capable of preventing the development of tumour diseases and stimulation of cytotoxic T-lymphocytes can repress existing tumours. A new class of antibody-based medication, the immune checkpoint inhibitors, influences the activation of T-lymphocytes. Immune checkpoint inhibitors are active against a number of tumours. In some cases, such as malignant melanoma and non-small cell lung cancer, the response rates are impressive and exceed those achieved with conventional chemotherapies. Modern immunotherapies in oncology show tumour response patterns differing from conventional chemotherapies including initial pseudo-progression which can occur in up to 10% of cases depending on the immunomodulating drug and tumour entity. Response Evaluation Criteria in Solid Tumours (RECIST 1.1) represent the currently most used response criteria for conventional chemotherapy of solid tumours. However, atypical response patterns of immunotherapies are not correctly classified using RECIST 1.1 so that the effectiveness is also incorrectly interpreted. To correctly interpret these atypical response patterns, special Immune-Related Response Criteria in Solid Tumours (iRECIST) have been published. iRECIST was developed only for usage in trials testing modern immunotherapeutics. In contrast to RECIST 1.1, according to iRECIST an initially unconfirmed progressive disease (iUPD) requires confirmation (iCPD) in clinically stable patients by subsequent control imaging after 4-8 weeks. New lesions are separately assessed within iRECIST.
1. To learn about the concept of radiomics and individualised medicine.
2. To learn how radiomics can be extracted from standard clinical examinations.
3. To appreciate the consequences of radiomics for radiologists in the future.
Radiomics is an emerging translational field of research, aiming to extract data from clinical images, containing information that may reflect the underlying pathophysiology of tumoural tissue. The extracted information may be associated with clinical data, and can be used to assess prognosis and to support clinical decision. Specific softwares allow the extraction of radiomic features, representative of the entire tumors or defined subvolumes within tumors, from digital images (CT, MR, PET), and convert them into mineable high dimensional data for hypothesis generation, testing, or both. The steps necessary for a radiomic approach to digital radiological examinations include: acquisition of the images; identification of volumes of interest that may contain prognostic value; segmentation of volumes; extraction of radiomic features from the volume; clustering of the features; creation of a database; inclusion of the extracted data to develop models to predict outcomes, possibly in combination with demographic, clinical, comorbidity, or genomic data. Imaging is used in routine practice for oncological patients worldwide, at many stages of diagnosis and treatment. In the current era of targeted therapies, radiomics guarantees a nearly limitless supply of imaging biomarkers over time during and after therapy, to quantify and monitor phenotypic changes many times during treatment. The power of a predictive classifier model is dependent on the amount of data; hence, it is desirable that the radiomic studies will consider sharing of data between different centers, with the creation of databases including radiomics data and covariates, such as genomic profiles, histology, serum markers, patient histories, and biomarkers.
1. To learn about new established treatment options in interventional oncology.
2. To understand the role of pre- and post-treatment imaging in increasing clinical outcome.
3. To appreciate potential future application of interventional oncology.
Oncologic liver interventions play an important role in patients management, specially in HCC, colorectal cancer, and neuroendocrine tumors. Percutaneous, ablative techniques (thermal ablation (RFA, MWA, brachytherapy) and transarterial techniques (TACE, TAE, RE/SIRT) are available. Precise pre-interventional imaging is essential to select the correct patients for these techniques. In transarterial liver interventions enhanced intraprocedural imaging with ultrasound and cone-beam-CT increased technical opportunities for patients treatment and widened the opportunities for interventional oncology.