Charlie Sayer MBBS, FRCR, Presenter: Nothing to Disclose

Tim Benepal, Abstract Co-Author: Nothing to Disclose

Arjun Nair MBBCh, FRCR, Abstract Co-Author: Nothing to Disclose

Myrna Cobos Barco Godoy MD, PhD, Abstract Co-Author: Nothing to Disclose

Ioannis Vlahos MRCP, FRCR, Abstract Co-Author: Research Consultant, Siemens AG Research Consultant, General Electric Company

Tumor recurrence is common. o 30-40% of surgically treated stage 1 lung cancer recur due to undetected micrometastases o Early recurrence on imaging may be missed o Early recognition potentiates the success of second line therapy. Genetic heterogeneity is common. o New therapies based on genetic mutations improve NSCLC outcome o Resistance due to new genetic mutations/transformation is common o 15% transform to small cell cancer, or develop other defects (50% T790M, 5% MET amplification) (Sequist 2011, Sci Trans Med). Expansion of treatment resistant clones and genetic transformation indicates need for therapy change. Surveillance of new therapies may differ from RECIST/WHO criteria and determine when rebiopsy is indicated.

3 international lung cancer treatment centers. Cases to demonstrate: • Expected timelines and locations for disease recurrence • Influence of initial therapy (surgery, chemoradiation, biologic) on RECIST/WHO criteria, imaging appearances/progression • Unusual patterns of spread – Imaging protocols to address • Pitfalls of progression – biologic therapy, bone disease • Tumor heterogeneity and evolution on treatment • Tumor genetic/histological transformation – when to re-biopsy to change treatment or rechallenge with original therapy

http://abstract.rsna.org/uploads/2014/14012516/14012516_ubtt.pdf

Sayer, C, Benepal, T, Nair, A, Godoy, M, Vlahos, I, Progression and Recurrence of Lung Cancer: Established Patterns and New Concepts.  Radiological Society of North America 2014 Scientific Assembly and Annual Meeting, - ,Chicago IL. http://archive.rsna.org/2014/14012516.html