Cancer recurrence is often associated with residual disease missed on imaging

The journal Oncotarget, Volume 16 of March 13, 2025 published a new editorial titled “No Disease Left Behind.”

In this editorial, Dr. Muzamil Arshad of the University of Chicago Medical Center and colleagues draw attention to a growing problem in cancer treatment: radiotherapy can leave behind microscopic cancer, even when scans show that the tumor has disappeared. The authors argue that this “residual disease” is more common than expected and is associated with worse long-term outcomes. Their viewpoint calls for a rethinking of how treatment success is evaluated and how cancer is monitored after therapy.

Radiotherapy, especially its variant known as stereotactic ablative radiotherapy (SABR), is widely used to treat cancers of the lung, liver, prostate and other organs. SABR delivers a high dose of radiation with exceptional accuracy and often shows excellent imaging results. However, the authors emphasize that relying on imaging alone may not provide a complete picture. Months and even years later, repeat biopsies often reveal cancer cells that imaging studies failed to detect.

This gap between what imaging shows and what is found on tissue examination can have serious consequences. Studies of several cancers have shown that patients with residual disease – even if it is small – are more likely to have cancer recurrence and reduced survival. This pattern holds true for colon, cervical, prostate and liver cancers, among others. In some cases, incomplete destruction of a tumor may lead to its spread to distant organs.

The authors note that a complete response on a scan does not always indicate complete disappearance of the tumor. This discrepancy can mislead physicians and patients alike into thinking that treatment has been more successful than it actually has. The editorial calls for more regular use of biopsy-based assays and new strategies to improve the true efficacy (or “ablative capacity”) of SABR.

They also discuss promising approaches to improve outcomes, including increasing radiation dose and combining radiotherapy with other treatments such as immune checkpoint inhibitors. Although some studies have shown better tumor control with these combinations, the results have not been consistent and more research is needed to clarify these strategies.

To summarize, this editorial encourages the oncology community to look beyond imaging. Residual cancer can persist even with “clean” scans, and recognizing this hidden threat is key to improving long-term outcomes. The goal is not only to shrink tumors on screen, but to eliminate the disease altogether.

Teknon Medical Center Spain,Barcelona 5.00 (1 review)Leave a request

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Sant Joan de Déu Children's Hospital Spain,BarcelonaLeave a request

Published: 24.03.2025

Updated: 23.03.2025

Medical author, Medical editor:

Stepan Yuk

Medical expert:

PhD. Olexandr Voznyak