ABSTRACT
En los últimos años la inmunoterapia (particularmente los inhibidores de los puntos de control inmunitario) ha suscitado un gran interés en el tratamiento de los pacientes con cáncer de pulmón, revolucionando el manejo de los pacientes con tumores localmente avanzados/metastásicos y generando esperanzas entre los pacientes y los médicos que diagnostican y tratan a estos enfermos. Estos fármacos se han convertido (combinados o no con otras terapias) en el tratamiento estándar de muchos pacientes con cáncer de pulmón y se espera que su uso aumente significativamente en un futuro próximo. En este manuscrito revisaremos la importancia creciente de las técnicas de imagen en la valoración de respuesta al tratamiento con inmunoterapia de los pacientes con cáncer de pulmón, haciendo hincapié en los nuevos criterios radiológicos específicos de respuesta con inmunoterapia, en las respuestas radiológicas atípicas (seudoprogresión, respuestas disociadas, hiperprogresión) y en las principales manifestaciones radiológicas de los eventos adversos asociados a la inmunoterapia (reacciones sarcoideas, toxicidades pulmonares, etc.). Los neumólogos deben conocer no solo las respuestas radiológicas atípicas de la inmunoterapia y sus implicaciones pronósticas, sino también sus efectos secundarios y los nuevos criterios radiológicos de respuesta desarrollados para valorar la respuesta al tratamiento. En este trabajo se tratarán conceptos claves como «seudoprogresión», «respuesta paradójica», «hiperprogresión» o «progresión no confirmada» y su significado en el manejo de los pacientes con cáncer de pulmón tratados con inmunoterapia
Immunotherapy (particularly immune checkpoint inhibitors) in the treatment of patients with lung cancer has aroused great interest in recent years, revolutionized the management of patients with locally advanced/metastatic disease, and given hope to both patients and treating physicians. These drugs, in combination or in monotherapy, have become the standard treatment for many patients with lung cancer, and their use is expected to increase significantly in the near future. In this article, we will review the growing importance of imaging techniques in the evaluation of therapeutic response to immunotherapy in lung cancer patients, with emphasis on the new specific radiological criteria on response to immunotherapy, atypical radiological responses (pseudoprogresion, dissociative responses, hyperprogresion), and the main radiological manifestations of adverse events associated with immunotherapy (sarcoid reactions, pulmonary toxicities, etc.). Pulmonologists must be familiar not only with atypical radiological responses to immunotherapy and their prognostic implications, but also with their effects and the new radiological criteria of response to assess treatment response. In this study, we will address key concepts such as "pseudoprogresion", "paradoxical response", "hyperprogresion", or "unconfirmed progression", and their significance in the management of patients with lung cancer treated with immunotherapy
Subject(s)
Humans , Lung Neoplasms/diagnostic imaging , Lung Neoplasms/therapy , ImmunotherapyABSTRACT
Immunotherapy (particularly immune checkpoint inhibitors) in the treatment of patients with lung cancer has aroused great interest in recent years, revolutionized the management of patients with locally advanced/metastatic disease, and given hope to both patients and treating physicians. These drugs, in combination or in monotherapy, have become the standard treatment for many patients with lung cancer, and their use is expected to increase significantly in the near future. In this article, we will review the growing importance of imaging techniques in the evaluation of therapeutic response to immunotherapy in lung cancer patients, with emphasis on the new specific radiological criteria on response to immunotherapy, atypical radiological responses (pseudoprogresion, dissociative responses, hyperprogresion), and the main radiological manifestations of adverse events associated with immunotherapy (sarcoid reactions, pulmonary toxicities, etc.). Pulmonologists must be familiar not only with atypical radiological responses to immunotherapy and their prognostic implications, but also with their effects and the new radiological criteria of response to assess treatment response. In this study, we will address key concepts such as "pseudoprogresion", "paradoxical response", "hyperprogresion", or "unconfirmed progression", and their significance in the management of patients with lung cancer treated with immunotherapy.
Subject(s)
Lung Neoplasms , Diagnostic Imaging , Humans , Immunotherapy/adverse effects , Lung Neoplasms/therapy , PrognosisABSTRACT
No disponible
Subject(s)
Humans , Male , Adult , Pneumothorax/diagnostic imaging , Erdheim-Chester Disease/diagnostic imaging , Biopsy , Pneumothorax/complications , Erdheim-Chester Disease/pathology , Erdheim-Chester Disease/surgery , Tomography, Emission-Computed/methodsSubject(s)
Erdheim-Chester Disease/complications , Pneumothorax/etiology , Biomarkers , Chest Pain/etiology , Chest Tubes , Dyspnea/etiology , Emergencies , Erdheim-Chester Disease/diagnostic imaging , Erdheim-Chester Disease/pathology , Histiocytes/chemistry , Histiocytes/pathology , Humans , Male , Pneumothorax/surgery , Thoracostomy , Tomography, X-Ray Computed , Young AdultSubject(s)
Adenocarcinoma/diagnostic imaging , Clavicle/diagnostic imaging , Lung Neoplasms/diagnostic imaging , Lymphadenopathy/diagnostic imaging , Neurilemmoma/diagnostic imaging , Positron Emission Tomography Computed Tomography/methods , Adenocarcinoma of Lung , Aged , Clavicle/pathology , Fluorodeoxyglucose F18 , Humans , Male , Neurilemmoma/pathologyABSTRACT
No disponible
Subject(s)
Humans , Female , Middle Aged , Cysts/diagnosis , Hemorrhage/diagnosis , Paraproteinemias/complications , Immunoglobulin Light Chains , Multiple Myeloma/complicationsSubject(s)
Adenoma/diagnostic imaging , Mediastinal Neoplasms/diagnostic imaging , Neoplasms, Multiple Primary/diagnostic imaging , Paraganglioma/diagnostic imaging , Pituitary Neoplasms/diagnostic imaging , Adenoma/pathology , Adenoma/surgery , Adult , Electron Transport Complex II/genetics , Female , Humans , Magnetic Resonance Imaging/methods , Mediastinal Neoplasms/genetics , Mediastinal Neoplasms/surgery , Neoplasms, Multiple Primary/genetics , Neoplasms, Multiple Primary/surgery , Paraganglioma/genetics , Paraganglioma/surgery , Pedigree , Pituitary Neoplasms/genetics , Pituitary Neoplasms/surgery , Rare Diseases , Risk Assessment , Syndrome , Tomography, X-Ray Computed/methods , Treatment OutcomeSubject(s)
Bronchogenic Cyst/complications , Hemorrhage/etiology , Immunoglobulin Light Chains , Lung Diseases/etiology , Multiple Myeloma/complications , Bronchogenic Cyst/diagnostic imaging , Female , Hemorrhage/diagnostic imaging , Humans , Lung Diseases/diagnostic imaging , Middle Aged , RadiographyABSTRACT
No disponible
Subject(s)
Humans , Female , Young Adult , Adenocarcinoma/complications , Adenocarcinoma/diagnosis , Radiography, Thoracic/instrumentation , Radiography, Thoracic/standards , Radiography, Thoracic , Lung Neoplasms/complications , Lung Neoplasms , Finger Phalanges/pathology , Finger Phalanges , Adenocarcinoma/pathology , Adenocarcinoma , Finger Joint/pathology , Finger Joint , Hand/pathology , Hand , Neoplasm Metastasis/pathology , Neoplasm MetastasisABSTRACT
No disponible