Evolving Roles: Review Article Suggests that Radiologists Need to Solidify Their Position on Cancer Teams

Leesburg, VA, July 26, 2016—Given the anticipated increase in cancer imaging over the next decade [1, 2], radiologists need to solidify their position as central members of the cancer team by identifying toxicity early and understanding the implications of their findings.

In an article titled, “A New Look at Toxicity in the Era of Precision Oncology: Imaging Findings, Their Relationship With Tumor Response, and Effect on Metastasectomy,” a team of radiologists and researchers led by Stephanie A. Holler Howard, of the Department of Radiology at the Dana Farber Cancer Institute in Boston, aims to broaden the radiologist’s understanding of imaging-evident toxicity.

The review article, published in the July 2016 issue of the American Journal of Roentgenology, is available through open access on the American Roentgen Ray Society’s website at www.arrs.org.

Oncologists are increasingly using combinations of cytotoxic agents, molecular-targeted therapies, and immune checkpoint inhibitors to achieve disease control. Although numerous articles have examined how to optimize tumor response criteria for patients treated with these new agents, little has been written about how a radiologist’s approach to imaging findings of toxicity should evolve.

“This article attempts to expand the radiologist’s view of the effect of imaging-evident toxicity by delineating how oncologists grade toxicity, highlighting the potential relationship between toxicity and drug efficacy, discussing how toxicity affects patients who may ultimately undergo metastasectomy, and exploring the effect of combining multiple drug classes on severity of adverse events,” Howard said.

Combinations of drug classes may amplify toxicity, yet acceptable levels of toxicity may be welcomed as a biomarker of treatment response in selected settings. Toxicity in organs that could benefit from future metastasectomies may be less acceptable as the role of surgical resection in advanced disease increases.

Newer drugs often work across many tumor types, and oncologists are increasingly experimenting with drug combinations. Toxicity with drugs in combination, however, has been unpredictable and often far more severe than when drugs are used in isolation.

“Radiologists must understand the language and multifaceted nuances of toxicity to contribute to optimized care of cancer patients and remain relevant effective members of the oncologic team,” Howard said.

The study may be viewed here, while the July 2016 issue of AJR may be accessed here.


  1. Mariotto AB, Yabroff KR, Shao Y, Feuer EJ, Brown ML. Projections of the cost of cancer care in the United States: 2010-2020. J Natl Cancer Inst 2011; 103:117–128
  2. Howard SA, Krajewski KM, Weissman BN, Seltzer SE, Ramaiya NH, Van den Abbeele AD. Cancer imaging training in the 21st century: an overview of where we are, and where we need to be. J Am Coll Radiol 2015; 12:714–720

Founded in 1900, ARRS is the first and oldest radiology society in the United States, and is an international forum for progress in radiology. The Society's mission is to improve health through a community committed to advancing knowledge and skills in radiology. ARRS achieves its mission through an annual scientific and educational meeting, publication of the American Journal of Roentgenology (AJR) and InPractice magazine, topical symposia and webinars, and print and online educational materials. ARRS is located in Leesburg, VA.