3177 - Imaging Biomarkers for Early Detection, Monitoring and Prediction of Radiotherapy-Related Side Effects - A Scoping Review
Presenter(s)
N. A. West1, E. Gioscio2, A. Abravan3, J. Shortall4, G. Rambaldi Guidasci5, V. Panettieri6, D. Farris7, P. van Luijk8, C. D. Fuller9, C. Fiorino10, R. Jeraj11, T. Rancati2, and L. Humbert-Vidan12; 1Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, 2Data Science Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy, 3Institute of Genetics and Cancer, University of Edinburgh, Edinburgh, UK; Division of Cancer Sciences, The University of Manchester,, Manchester, United Kingdom, 4Division of Cancer Sciences, The University of Manchester, Manchester, United Kingdom, 5Medical Physics Unit, Department of Radiotherapy and Medical Oncology and Radiology, Isola Tiberina – Gemelli Isola Hospital, Rome, Italy, 6Peter MacCallum Cancer Centre, Melbourne, VIC, Australia, 7Research Medical Library, The University of Texas MD Anderson Cancer Center, Houston, TX, 8Department of Radiation Oncology, University Medical Center Groningen, University of Groningen, Groningen, Netherlands, 9Division of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, 10Medical Physics, IRCCS San Raffaele Scientific Institute, Milan, Italy, 11Department of Medical Physics and Human Oncology, University of Wisconsin, Madison, WI, 12Radiation Oncology Group, Vall d’Hebron Institute of Oncology, Barcelona, Spain
Purpose/Objective(s): Radiotherapy (RT)-related side effects remain a major clinical challenge and vary widely between patients. Current assessment relies on clinician- and patient-reported measures, which are subjective and often detect damage after it has occurred. Studies show that imaging biomarkers (IBM) enable non-invasive detection, monitoring, and prediction of normal tissue injury, but few have translated into clinical practice. To understand this gap, we performed a scoping review to map IBM for RT-related side effects and examine their stage of clinical translation.
Materials/Methods: This scoping review followed PRISMA-ScR guidelines (protocol in OSF, DOI: 10.17605/OSF.IO/CVMUJ). MEDLINE (Ovid), Embase (Ovid), and Cochrane Library (Wiley) were searched from inception to 22 January 2025. Controlled vocabulary (MeSH, Emtree) and free-text terms related to IBM and RT-related side effects were used. Only peer-reviewed full-text clinical studies were eligible. Screening and data extraction were performed independently in Covidence, with discrepancies resolved by consensus.
Results: 3,503 results were retrieved with 2,733 unique results identified for eligibility screening and 104 studies included for final analysis. Key results identified that 98.3% of studies did not seek clinical implementation or regulatory approval. Results stratified by cancer type are shown in Table 1.
Conclusion: Despite increasing prospective and longitudinal research, IBM for RT-related toxicities remain mostly investigational, with minimal clinical implementation and regulatory approval. The gap between IBM discovery and adoption appears driven by methodological heterogeneity, limited integration with dosimetry, and absence of high-level interventional validation.
Table 1| % of total | |||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|
| Metric | Head and Neck | Neurologic | Thoracic | Gastrointestinal | Breast | Genitourinary | Skin | Gynecologic | Hematologic | Total | |
| Occurrence | 30.0 | 29.2 | 16.7 | 10.8 | 5.8 | 4.2 | 1.7 | 0.8 | 0.8 | 100 | |
| Clinical real-world data Clinical trial | 27.5 2.5 | 25.8 3.3 | 13.3 3.3 | 8.3 2.5 | 3.3 2.5 | 2.5 1.7 | 0.8 0.8 | - 0.8 | - 0.8 | 81.7 18.3 | |
| Prospective Retrospective | 15.0 15.0 | 15.8 13.3 | 6.7 10.0 | 5.8 5.0 | 5.0 0.8 | 3.3 0.8 | 1.7 - | 0.8 - | 0.8 - | 55.0 45.0 | |
| Cross-sectional Longitudinal | 12.5 17.5 | 7.5 21.7 | 2.5 14.2 | 5.8 5.0 | 0.8 5.0 | 0.8 3.3 | - 1.7 | - 0.8 | - 0.8 | 30.0 70.0 | |
| Qualitative Quantitative | 1.7 28.3 | 3.3 25.8 | 2.5 14.2 | - 10.8 | 0.8 5.0 | - 4.2 | - 1.7 | - 0.8 | 0.8 - | 9.2 90.8 | |
| CBCT CT MRI Other PET-CT | - 4.2 20.8 0.8 4.2 | - - 28.3 - 0.8 | 0.8 10.0 2.5 0.8 2.5 | - 2.5 6.7 0.8 0.8 | - 0.8 4.2 0.8 - | - - 4.2 - - | - 0.8 0.8 - - | - - 0.8 - - | - - 0.8 - - | 0.8 18.3 69.2 3.3 8.3 | |
| Correlation with clinical outcomes | Yes No | 28.3 1.7 | 20.8 8.3 | 12.5 4.2 | 10.0 0.8 | 4.2 1.7 | 2.5 1.7 | 1.7 - | 0.8 - | - 0.8 | 80.8 19.2 |
| Correlation with radiation dose | Yes No | 20.0 10.0 | 14.2 15.0 | 7.5 9.2 | 6.7 4.2 | 4.2 1.7 | 3.3 0.8 | - 1.7 | 0.8 - | - 0.8 | 56.7 43.3 |
| Clinical implementation | Yes No | - 30.0 | - 29.2 | - 16.7 | 0.8 10.0 | - 5.8 | - 4.2 | 0.8 0.8 | - 0.8 | - 0.8 | 1.7 98.3 |
| Regulatory approval | Yes No | - 30.0 | - 29.2 | 1.7 15.0 | - 10.8 | - 5.8 | - 4.2 | - 1.7 | - 0.8 | - 0.8 | 1.7 98.3 |