How Do Imaging and Biomarkers Refine CNS Radiation Selection?

The integration of molecular biomarkers and sophisticated imaging techniques is redefining treatment selection and assessment in central nervous system (CNS) radiation oncology, according to Charlotte Ivy Rivers, MD, a radiation oncologistat Medical University of South Carolina. Rivers centers these advancements as pivotal factors that have significantly matured within the clinical landscape over the last 5 years.

Rivers highlighted that biomarkers are exerting a profound influence on clinical practice, specifically citing the updated World Health Organization criteria for primary gliomas. This shift in classification has altered diagnostic workflows and redefined the eligibility of patients with cancer for various therapeutic agents.

Beyond gliomas, the molecular profiling of meningiomas represents a burgeoning area for clinical growth. By examining specific molecular features, clinicians can more accurately predict how these tumors will behave. This predictive capability is essential for determining the necessity of radiation therapy or the introduction of other targeted interventions.

Radiographic assessment has similarly evolved through the increased adoption of functional imaging to guide treatment targeting. Rivers specifically notes the utility of DOTATATE-PET scans in helping to direct clinical management.

Furthermore, Rivers points to the clinical value of contrast-clearance analysis in the post-treatment setting. This technique provides essential clarity when distinguishing between recurrent tumor and radiation necrosis, addressing a frequent diagnostic challenge in neuro-oncology. Together, these imaging and biomarker advancements represent a rapid period of innovation that continues to enhance the precision of CNS radiation oncology.

Transcript:

How are advanced imaging and emerging biomarkers affecting selection, targeting, and assessment in CNS radiation?

Those factors are influencing a lot of things, the biomarkers, in particular. Especially, [because] the whole classification for primary gliomas changed with the new WHO criteria. That’s changed a lot of how we diagnose patients, and what drugs they’re eligible for. In meningiomas as well, that’s an area for growth, looking at molecular features of meningiomas to try to predict how they’re going to behave and whether they need radiation or other targeted therapies. Then, imaging-wise, we have been using more functional imaging or different things like DOTATATE-PET scans to help guide treatment. Then, things like contrast-clearance analysis to help us determine what is tumor and what is radiation necrosis. Those are things that have been changing a lot, even in the last 5 years.