E5261. Assessment of Immunotherapy, Chemotherapy, and Radiotherapy Treatment-Related Complications in Oncologic Patients
  1. Ilana Warsofsky; Brigham and Women's Hospital
  2. Angela Giardino; Brigham and Women's Hospital
  3. Katie Krajewski; Brigham and Women's Hospital
Cancer has been established as one of the second leading causes of death per the CDC. To guide cancer care, patients undergo cross-sectional imaging at time of diagnosis, during treatment, and on surveillance. Knowledge of the treatment regimen can affect the appropriate interpretation of imaging findings. It is important to be able to recognize complications in patients undergoing treatment for their malignancy in the era of precision medicine with targeted treatments for patient’s tumor profile, as it can often lead to abrupt change in the regimen. It is critical for radiologists to be able to recognize and interpret the findings across modalities including especially CT and MRI.

Educational Goals / Teaching Points
The goal of this exhibit is to provide an organized approach to critical findings performed during a patient’s treatment. Teaching points will be illustrated using an organ system approach and case-based format. The mechanism of action of immune checkpoint inhibitor therapy will be illustrated when applicable to understand the imaging findings. Key images will be selected to depict the findings.

Key Anatomic/Physiologic Issues and Imaging Findings/Techniques
This educational exhibit will demonstrate critical findings in the neurologic, cardiovascular, gastrointestinal, and genitourinary system. Cases will include but not limited to: hypophysitis, pneumonitis, sarcoidlike reaction, pericarditis, vascular thrombosis, hepatic steatosis, pancreatitis, pneumatosis, colitis, and hemorrhagic cystitis. Examples of postprocedural, postsurgical, and postradiation complications include hepatic infarct post embolization, subcapsular hemorrhage, intrahepatic biloma, radiation enteritis, mesenteric hematoma, prostatic abscess, urinary leak, insufficiency fractures, avascular necrosis of the femoral heads, and spinal cord compression.

It is imperative that radiologists who review cancer imaging studies recognize findings from head to toe that are sequela of treatments including the increased use of immune checkpoint inhibitors which are increasingly being used in both clinical trials and as standard of care. The accurate interpretation of these studies will ensure oncologists make the best decisions for their patients. After completing this exhibit, the radiologist should be aware of expected changes post chemotherapy, immunotherapy, and radiation therapy as well as identification of residual or recurrent tumor and changes of pseudo progression.