In the statement they also highlight the evidence gaps for routine follow-up brain tumour imaging, in the hope it will pave the way for progress in evidence-based imaging.
Clinicians use brain scans at predetermined times to assess if a brain tumour patient is responding to treatment but scanning frequency can range from every few weeks to every few months. Different countries and hospitals use different approaches, but it is a real problem determining the best course based on evidence.
The James Lind Alliance has identified the effect of interval scanning on prognosis as one of the top 10 research priorities for neuro-oncology.
Dr Robin Grant, Centre for Clinical Brain Sciences, University of Edinburgh and Dr Tom Booth, School of Biomedical Engineering & Imaging Sciences at King’s College London, initiated the project which would not have been possible without the NCRI Group. The NCRI Group structure enabled collaboration across group members and an extended network of key opinion leaders in the UK.
Helen Bulbeck, Brainstrust, also supported the project.
Representatives of all UK stakeholders convened in April 2019 in conjunction with an NCRI Brain Group workshop to discuss the evidence for interval imaging pathways for different tumour types. Attendees represented charities, neuro-oncologists, neuro-surgeons, neuro-radiologists, neuro-psychologists, trialists, health economists, data scientists and imaging industries.
The group found very little evidence to support the current imaging interval schedules, highlighting that a brain scan only gives a snapshot view of the brain tumour at a specified time.
The resulting position statement highlights the lack of evidence in this area and proposes potential solutions to generate an evidence base. The treatment complexity of brain tumours and their relative rarity means that solutions beyond traditional “randomised controlled trials” alone are required. The wide range of future studies suggested, and how they might build the required body of evidence, are particularly relevant to all researchers in this field.
Members of the NCRI Brain Group are confident that ongoing collaborative efforts will improve trial design and generate the evidence to optimise monitoring imaging biomarkers in standard of care brain tumour management.