Immunotherapy has revolutionized oncology care, improving patient outcomes in several cancers. However, these therapies are also associated with typical immune-related adverse events due to the enhanced inflammatory and immune response. These toxicities can arise at any time during treatment but are more frequent within the first few months. Any organ and tissue can be affected, ranging from mild to life-threatening. While some manifestations are common and more often mild, such as dermatitis and colitis, others are rarer and more severe, such as myocarditis. Management depends on the severity, with treatment being held for >grade 2 toxicities. Steroids are used in more severe cases, and immunosuppressive treatment may be considered for non-responsive toxicities, along with specific organ support. A multidisciplinary approach is mandatory for prompt identification and management. The diagnosis is primarily of exclusion. It often relies on imaging features, and, when possible, cytologic and/or pathological analyses are performed for confirmation. In case of clinical suspicion, imaging is required to assess the presence, extent, and features of abnormalities and to evoke and rule out differential diagnoses. This imaging-based review illustrates the diverse system-specific toxicities associated with immune checkpoint inhibitors and chimeric antigen receptor T-cells with a multidisciplinary perspective. Clinical characteristics, imaging features, cytological and histological patterns, as well as the management approach, are presented with insights into radiological tips to distinguish these toxicities from the most important differential diagnoses and mimickers—including tumor progression, pseudoprogression, inflammation, and infection—to guide imaging and clinical specialists in the pathway of diagnosing immune-related adverse events.
免疫疗法已彻底改变肿瘤治疗模式，在多种癌症中改善了患者预后。然而，这些疗法因增强炎症和免疫反应而引发典型免疫相关不良事件。毒性反应可在治疗期间任何时间出现，但更常见于初始数月内。任何器官和组织均可受累，严重程度从轻微至危及生命不等。虽然某些表现（如皮炎和结肠炎）较为常见且多属轻度，但其他如心肌炎等则更为罕见且严重。处理方式取决于严重程度，2级以上毒性需暂停治疗。重症病例使用类固醇，对无应答毒性可考虑免疫抑制治疗及特定器官支持。及时识别和处理必须采用多学科协作模式。诊断主要采用排除法，常依赖影像学特征，条件允许时通过细胞学和/或病理学分析确认。临床疑似病例需影像学检查评估异常的存在、范围和特征，并进行鉴别诊断排查。本基于影像学的综述从多学科视角阐释了免疫检查点抑制剂和嵌合抗原受体T细胞相关的多系统特异性毒性，通过临床特征、影像学表现、细胞与组织学模式及处理策略的阐述，重点提供影像学鉴别要点，以区分肿瘤进展、假性进展、炎症及感染等重要鉴别诊断与模拟病变，为影像与临床专家诊断免疫相关不良事件提供路径指引。
肿瘤(癌症)患者之家