The EORTC Cancer Imaging Programme
detection of anticancer activity, prediction of efficacy, detection of drug resistance and identification of tumour phenotypes associated with response are all possible. In addition, imaging biomarkers can be used to target specific biological pathways.
Imaging will play an increasingly important role in personalised cancer therapy, and a means to co-ordinate imaging within cancer clinical trials needs to be put in place now. For this reason, the EORTC has initiated a cancer imaging programme in order to further its mission to improve the standard of cancer treatment through the testing of more effective therapeutic strategies.
The EORTC
For nearly 50 years, the EORTC, an international organisation under Belgian law, has been developing, conducting,
co-ordinating
and stimulating translational and clinical research in Europe aiming to improve the management of cancer and related problems by increasing survival but also patient quality of life. Extensive and comprehensive research in this field is often beyond the means of individual European hospitals and can best be accomplished through the multidisciplinary, multinational efforts of basic scientists and clinicians.
The current EORTC Network comprises over 300 hospitals or cancer centres in over 30 countries. Within this network, some 2,900 collaborators from all disciplines are involved in cancer treatment and research. More than 6,000 patients are entered into EORTC trials each year (database of more than 180,000 patients) and some 50,000 patients are in follow-up. Thirty-six trials are open to patient entry.
The EORTC imaging strategy is multifold. The EORTC plans to participate in major European initiatives that will advance the field of imaging. It is positioning itself as an international reference network for academia and industry, an organisation capable of forming partnerships between academia and industry so as to support the development of quantitative imaging in Belgian, European and trans- Atlantic clinical trials and thereby decrease delays between drug discovery and practice. The EORTC also plans to foster partnerships with other networks, be a key player for imaging training programmes and contribute to the changing clinical research environment for methodology, conduct and analysis, taking into account new imaging end-points in the decision rules.
In this regard, the EORTC has a mission to improve the quality and consistency of evaluation of cancer treatment within its clinical trials through the incorporation of imaging technologies used for treatment definition for radiotherapy, staging, prediction and evaluation of response, or pathology. The objectives of the EORTC imaging initiative were to build an image exchange platform at the EORTC Headquarters and to build the EORTC Imaging Group and a network with stakeholders in cancer imaging, stimulate the integration of imaging components into EORTC studies, participate in major EU initiatives and link up with US co-operative groups.
The EORTC aims to accelerate the access of cancer patients to more effective therapy, and we report here on the EORTC Imaging Platform, a platform that removes many sources of uncertainty in using imaging technologies in the assessment of drug response, and on the EORTC Imaging Group (formed in June 2009 to establish and maintain the scientific and clinical value of advanced imaging).
EUROPEAN ONCOLOGY
Data Reviewer’s computer
The EORTC Headquarters Imaging Platform
Before imaging can be successfully integrated into cancer clinical trials, an imaging platform must be built. An imaging platform is necessary because of the many barriers in place that hinder the flow of medical information (see Figure 1). Certainly, these barriers are necessary when one considers the confidentiality of medical information, but in order to conduct a cancer clinical trial a means must be found to effectively handle and evaluate the collected imaging data. An imaging platform is a means towards this end.
Prerequisites for an Imaging Platform
Any successful imaging platform should ensure the standardisation of the acquisition of imaging data as well as the quality of those data. The imaging platform should also be able to accommodate data coming from a variety of imaging technologies, such as CT, positron- emission tomography–computed tomography (PET-CT) or magnetic resonance imaging (MRI), among others.
The imaging platform needs to function within the clinical trial setting, and this means that it must be possible for an expert reviewer located at one institution to easily review imaging data that were collected at another. Therefore, the imaging platform needs to be set up so that imaging data can be uploaded from the clinical site and then stored in a central archiving system. The centrally stored data should then be accessible from the reviewer’s computer.
Besides the image itself, imaging data contain many other useful parameters. Parameters such as standard uptake value and quality assurance and quality control quantifiers are all commonly associated with an image, and these must be encoded in the transmitted data set.
Furthermore, the ideal imaging platform should allow for the integration of plug-ins that could automate quality assurance and quality control processes. This is necessary because it should only be possible for a reviewer to upload imaging data that have been validated in terms of quality assurance and quality control. Finally, the processing and analysis of imaging data must support visual analysis.
The EORTC Imaging Platform
The EORTC, in collaboration with Keosys and the EORTC Imaging Group, is building just such an imaging platform for the exchange and
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Figure 1: Firewalls Hinder the Sharing of Imaging Data Collected in Clinical Trials
Hospitals
Reviewers Data
EORTC Headquarters
Data
Internet
Data Storage/ Review Station
Hospital’s firewall
Reviewers
Internet
Reviewer’s computer
Hospital’s
firewall
Hospital’s firewall
Hospital’s
firewall
Hospital’s firewall
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