Non Size Based Morphology Criteria for Assessment of Response in Patients with Liver Metastases of Gastrointestinal Origin Receiving Systemic Treatment

Background and Aim: Liver is the main site of metastases of gastrointestinal cancers, chemotherapy with orwithout targeted therapy is the standard treatment. Radiologic assessment of tumor response is usually done bythe use of Response Evaluation Criteria in Solid Tumor (RECIST) criteria. RECIST depends on tumor size changes butit does not address morphologic changes as overall attenuation, enhancement and tumor liver interface changes whichmay shown early before tumor size changes. We aimed to evaluate use of contrast enhanced computed tomography(CECT) new morphologic criteria in assessment of response in patients with hepatic metastases of gastrointestinalorigin. Methods: This study was carried out by cooperation between Clinical Oncology and Nuclear Medicine andRadiodiagnosis Departments, Faculty of Medicine, Menoufia University. During the period from April 2015 to December2016 forty patients with stage IV gastrointestinal cancers with hepatic metastases were included, CECT was donebefore and after systemic treatment, response evaluation was done by RECIST 1.1 and morphology response criteriac.Results: By RECIST, partial response (PR) observed in 57.5%, stable disease (SD) 22.5% and progressive disease (PD)in 20% of patients compared to Optimal response 42.5%, incomplete response 35% and no response in 22.5% of patientsby Morphologic response criteria. Regarding survival, patients with PR had median survival of 20 months (95% CI,17.988 to 22.012months) versus 11 months (95% CI, 1.235 to 8.580 months) in SD or PD by RECIST, (P=.002). whileby morphology response criteria the median overall survival of optimally responded patients 23 months (95% CI, 20.04to 27.81months) versus 16 months (95% CI, 5.590 to 5.044 months) in patients with incomplete or no morphologicresponse (P=.001). Conclusion: Morphologic response criteria are accurate method for assessment of response ofhepatic metastases and correlated well with patients’ survival and better to be incorporated to treatment evaluation.     

Inadequacy of the new Response Evaluation Criteria in Solid Tumors (RECIST) in patients with malignant pleural mesothelioma: report of four cases

Unidimensional Response Evaluation Criteria in Solid Tumor (RECIST) has been recently proposed in the attempt to simplify the standardized bidimensional World Health Organization (WHO) criteria. The complete accord between these two measurement systems was established in a large comparative study [J. Natl. Cancer Inst. 92(3) (2000) 205] that demonstrated the validity and the good performance of RECIST criteria. We report four cases of inadequacy of RECIST criteria in the evaluation of response to chemotherapy in patients with malignant pleural mesothelioma. These four patients were enrolled in two consecutive multicenter phase II clinical trials investigating the activity of a novel chemotherapy regimen in advanced pleural mesothelioma. They were judged as having an objective response to chemotherapy according to WHO criteria. Reassessed according to both methods, we found that results obtained with RECIST criteria do not correspond to WHO underestimating response to chemotherapy. Our data raise doubts about the applicability of unidimensional RECIST response criteria to mesothelioma and, possibly, to any tumor involving the chest wall.     

Tumor response assessment by modified Choi criteria in localized high‐risk soft tissue sarcoma treated with chemotherapy

BACKGROUND.

The objective of this study was to compare the prognostic relevance of Response Evaluation Criteria in Solid Tumors (RECIST) versus Choi criteria for the assessment of response in patients with high‐risk soft tissue sarcoma of the extremities or trunk wall who received preoperative chemotherapy with or without radiotherapy in a phase 3 trial.

METHODS.

Patients received 3 cycles of preoperative epirubicin + ifosfamide with or without radiotherapy. The diagnostic concordance between RECIST and Choi criteria and their correlation with overall survival (OS) and freedom from progression (FFP) were evaluated in a univariate Cox regression model.

RESULTS.

In 243 of 321 eligible patients, RECIST, Choi criteria, and histology were predictive for OS and FFP. In the subgroup of 69 patients who received chemotherapy alone and were evaluable by both RECIST and Choi criteria, Choi criteria were associated significantly with OS and FFP, whereas RECIST predicted only FFP, and the pattern of agreement observed between the 2 criteria was unsatisfactory. On a dichotomous scale, comparing objective response (complete and partial responses) and lack of response (stable and progressive disease) to preoperative chemotherapy according to RECIST and Choi criteria, only Choi criteria were predictive of OS and FFP, and fair agreement between RECIST and Choi criteria was observed. When lack of progression and progression were compared (complete and partial responses + stable disease vs progressive disease), both assessment criteria were significantly predictive of OS and FFP, and there was substantial agreement between the 2 criteria.

CONCLUSIONS.

Response to chemotherapy with or without radiotherapy was associated with a better outcome in patients with high‐risk soft tissue sarcoma. Choi criteria were better predictors than RECIST in patients who received preoperative chemotherapy alone. Cancer 2012. © 2012 American Cancer Society.     

Qu’apporte la réponse tumorale dans le cancer colorectal ?

Tumor size reduction after cancer treatment is evaluated by tumor response. It is often the primary objective of phase II clinical trials. The WHO and RECIST criteria are now internationally recognized for the quantification of tumor response in clinical trials. This literature review article focuses on the interest of measuring tumor response according to these criteria in terms of clinical benefit for patients with metastatic colorectal cancer (mCRC): metastasis resection, survival and improving quality of life. In patients with mCRC and initially resectable metastases, tumor response following preoperative chemotherapy is an independent prognosis factor for survival and a way of testing tumor sensitivity to the chemotherapy regime; it allows and/or facilitates metastases resection. In patients with mCRC and potentially resectable metastases, obtaining an objective tumor response to allow secondary metastasis resection is one of the primary objectives of chemotherapy. In patients with mCRC and non-resectable metastases, tumor response may provide individual benefit in terms of control of symptoms and quality of life and may favor a survival benefit. Despite the limitations of the RECIST criteria, no other morphological or functional radiological criterion has to date achieved consensus up in terms of availability, reproducibility, sensitivity, specificity, clinical relevance and cost. Finally, although there is no high-level of evidence, tumor response has prognostic value for metastases resection in mCRC and is a therapeutic objective in patients with potentially resectable metastases or symptomatic advanced disease.     

Comparison of WHO and RECIST Criteria for Evaluation of Clinical Response to Chemotherapy in Patients with Advanced Breast Cancer

When patients with advanced breast cancer (ABC) are treated with neoadjuvant chemotherapy (NACT),efficacy is monitored by the extent of tumor shrinkage. Since their publication in 1981, World Health Organization(WHO) guidelines have been widely practiced in clinical trials and oncologic practice, for standardized tumorresponse evaluation. With advances in cancer treatment and tumor imaging, a simpler criterion based on onedimensionalrather than bi-dimensional (WHO) tumor measurement, named Response Evaluation Criteriain Solid Tumors (RECIST) was introduced in 2000. Both approaches have four response categories: completeresponse, partial response, stable disease and progressive disease (PD). Bi-dimensional measurement data of151 patients with ABC were analysed with WHO and RECIST criteria to compare their response categoriesand inter criteria reproducibility by Kappa statistics. There was 94% concordance and 9/151 patients were recategorizedwith RECIST including 6/12 PD cases. RECIST therefore under-estimates and delays diagnosis ofPD. This is undesirable because it may delay or negate switch over to alternate therapy. Analysis was repeatedwith a new criteria named RECIST-Breast (RECIST-B), with a lower threshold for PD (≥10% rather than ≥20%increase of RECIST). This showed higher concordance of 97% with WHO criteria and re-categorization of only4/151 patients (1/12 PD cases). RECIST-B criteria therefore have advantages of both ease of measurement andcalculations combined with excellent concordance with WHO criteria, providing a practical clinical tool forresponse evaluation and offering good comparison with past and current clinical trials of NACT using WHOguidelines.     

Effect of Adding Bevacizumab to Chemotherapy on Pathologic Response to Preoperative Systemic Therapy for Resectable Colorectal Liver Metastases: A Systematic Review and Meta-analysis

BackgroundLiver-limited metastatic colorectal cancer is a potentially curable disease. Pathologic response (pR) to preoperative chemotherapy (CT) for colorectal liver metastases (CLM) is a surrogate endpoint for overall survival (OS). We conducted the first meta-analysis of observational studies to estimate the overall effect of bevacizumab on pR in preoperative systemic therapy for CLM.MethodsWe systematically searched PubMed, Cochrane Library, CINAHL, Web of Science, Embase, and LILACS for studies published between January 2004 and August 2019 that compared the pR of CT plus bevacizumab to CT alone as preoperative therapy for CLM. The primary endpoint was pathologic complete response (pCR). Secondary endpoints were pathologic major (pMaR) and minor (pMiR) response. Overall effects were expressed by odds ratios (ORs) and 95% confidence intervals (CIs) using a random-effects model.ResultsOf the 1,452 studies yielded by the search, 9 were eligible, totaling 1,202 patients (516 CT plus bevacizumab and 686 CT alone). The addition of bevacizumab to CT increased the pCR rate without reaching statistical significance (OR: 1.24, 95% CI 0.81 to 1.92, P = .32). However, pMaR was significantly higher (OR: 2.45, 95% CI 1.85 to 3.25, P < .001), and pMiR was significantly lower (OR: 0.41, 95% CI 0.31 to 0.54, P < .001), in the bevacizumab group. The analyses showed a low level of heterogeneity (I² = 0% to 6%). Publication bias was not found.ConclusionsThis meta-analysis demonstrates that bevacizumab plus preoperative CT is associated with higher rates of pR in CLM. Antiangiogenics might improve the OS of CLM patients and should be evaluated in randomized clinical trials.MicroAbstractThe benefit of perioperative chemotherapy for colorectal liver metastases (CLM) is uncertain, but pathologic response (pR) to preoperative chemotherapy is a strong prognostic factor. Our meta-analysis of observational studies compared the pR of bevacizumab plus chemotherapy to chemotherapy alone as preoperative systemic therapy in the management of CLM. The addition of bevacizumab was associated with significantly higher rates of pR.     

Retrospective analysis of pathological response in colorectal cancer liver metastases following treatment with bevacizumab

Aims

Pathological response has been shown to be a predictor for survival after preoperative chemotherapy and surgical resection of colorectal cancer liver metastases. This retrospective analysis evaluated the effect on pathological response of adding bevacizumab to standard neoadjuvant chemotherapy in patients with metastatic colorectal cancer (mCRC) and liver metastases.

Methods

Patient records from two Spanish centres were retrospectively examined for this analysis. Patients were included if they had stage IV mCRC with liver metastases, were unresectable or marginally resectable tumour before chemotherapy, and had oxaliplatin- or irinotecan-based chemotherapy, with or without bevacizumab, before resection. Tumour response was evaluated using response evaluation criteria in solid tumours (RECIST). Pathological response was assessed by pathologists blinded to treatment.

Results

Ninety-five patients were included. Good pathological responses (PR0/PR1) were observed in 37 patients (39 %). The RECIST response rate was 51 %. Only 42 % of patients with a good pathological response had a complete or partial response according to RECIST, while 57 % of those with a poor pathological response had a complete or partial response according to RECIST. RECIST response rates were similar with and without bevacizumab, although 49 % of bevacizumab-treated patients had a good pathological response versus 27 % of those receiving chemotherapy alone (χ ² P = 0.0302).

Conclusion

Pathological response may be a better indicator of treatment efficacy than RECIST for patients with mCRC receiving bevacizumab in the neoadjuvant setting. Adding bevacizumab to chemotherapy has the potential to increase pathological response rates. Well-designed prospective clinical studies are required to establish the efficacy and tolerability of this approach.     

Weekly docetaxel and cisplatin plus fluorouracil as a preoperative treatment for gastric cancer patients with synchronous multiple hepatic metastases: a pilot study

This pilot study was undertaken to assess the effect of weekly docetaxel, cisplatin and fluorouracil (DCF) as a preoperative treatment for gastric cancer with multiple synchronous hepatic metastases. Gastric cancer patients with synchronous multiple liver metastasis were first given preoperative chemotherapy consisting of two courses (each course consisted of 6-week administration and 2-week withdrawal) of weekly DCF regimen. Following the operation, postoperative chemotherapy and hepatic arterial infusion (HAI) treatment were performed as required. Eight patients completed two courses of preoperative chemotherapy with weekly DCF regimen. No toxicity of grade 3 or more was observed during the course of chemotherapy. The response rate was 100% according to the RECIST criteria. Seven of the patients have survived for over 1 year, and six of them are still alive after more than 1 year. Because of the unexpected high response to weekly DCF, we consider that it should be verified through phase II and III trials as an important part of the comprehensive treatment for gastric cancer with liver metastasis.     

Multidisciplinary approach of colorectal liver metastases

Colorectal cancer (CRC) is the second most common cause of cancer death in Spain. Fifty percent of patients will develop colorectal liver metastases (CLM) during the course of the disease. Less than 20% of patients with CLM are initially resectable and for them 5-year disease-free survival (DFS) is about 20-25%, with a high recurrence rate. CLM is a heterogeneous disease. From a clinical point of view, four main groups can be differentiated: initially resectable, not optimally resectable, unresectable that could be resectable and unresectable that never will be likely to be resected. Treatment of CLM must be established, always, in a multidisciplinary team discussion with an analysis of prognostic factors and resectability. For patients with resectable CLM, the EORTC trial 364 demonstrated that chemotherapy plus surgery is better than surgery alone. Consequently most patients should be treated with perioperative chemotherapy based on oxaliplatin, and if resection has been done without chemotherapy, they should receive adjuvant chemotherapy after R0 resection. Based on oncological factors, the 5-year survival rate after resection of CLM ranges from 60% to only 14% with a poor score. If a patient has more than one of the poor prognostic factors he should probably be referred for preoperative (induction) chemotherapy. Only a minority of patients with CLM are amenable to surgery; therefore, efforts have been made to increase the percentage of patients who could be candidates for resection. Studies, mostly retrospective, have confirmed the ability of neoadjuvant chemotherapy (conversion chemotherapy) to render some metastases resectable. The regimens we must use depend on the KRAS mutational status and the toxicity profiles of drugs in the context of each patient. In k-ras mutated tumours we can use bevacizumab combined with standard chemotherapy or concomitant administration of the three active agents (FOLFOXIRI) in suitable patients. In k-ras wild-type patients, the combination of cetuximab and FOLFIRI-FOLFOX improved response rates and resection rate in phase III-II trials. With a lower level of evidence, panitumumab is an alternative combined with FOLFOX. Bevacizumab is also an alternative as it does not depend on KRAS status. Radiotherapy is becoming an alternative in selected patients, where surgery is not an alternative. For the majority of patients, who will never be resectable, the continuum of care with chemotherapy will be the paradigm for their management.     

Neoadjuvant Chemotherapy Prior to Resection of Colorectal Liver Metastases

Surgery is the reference treatment of resectable colorectal liver metastases (CLM) as it is associated with 5-year survival rate as high as 50?% in selected patients. Unfortunately, most patients have too advanced metastatic disease to undergo liver resection with curative intent and are therefore treated by systemic chemotherapy. In patients undergoing resection of CLM, disease recurrence can occur in up to 70?% and consequently, adjuvant treatment to surgery have been tested to improve oncologic outcome. In patients with unresectable CLM, chemotherapy is initially the sole treatment option. The considerable improvement of the efficacy of anticancer agents has contributed to increase the response rate in patients with advanced colorectal cancer. In case of major response to chemotherapy, surgery with curative intent can be offered to patients with initially unresectable liver metastases.     

Pathologic response to bevacizumab-containing chemotherapy in patients with colorectal liver metastases and its correlation with survival

For patients with colorectal liver metastases (CLM), hepatic resection currently offers the best chance for long-term survival. Preoperative chemotherapy is now integral to the management of these patients, conferring a disease-free survival advantage over surgery alone in patients with ‘upfront’ resectable disease and enabling some initially unresectable CLM to become resectable. However, although surgery may improve long-term survival, up to 65.0% of patients will experience disease recurrence at 5 years and reliable prognostic factors are needed to predict those patients who are more likely to experience recurrence after resection. Recently, pathologic tumor response, defined as the ‘objective measurement of residual cancer cells in resected tissue,’ has been identified as a reliable prognostic factor in patients with colorectal cancer (CRC) receiving preoperative chemotherapy and has been shown to correlate with improved survival after resection of CLM. Addition of the targeted biologic agent bevacizumab to preoperative chemotherapy is associated with an increase in pathologic response rate and an increase in survival compared with chemotherapy alone in patients undergoing hepatic resection. This review discusses the data in support of pathologic response rate as an important new outcome endpoint after hepatic resection of CLM and considers the evidence to date on pathologic response to bevacizumab-containing chemotherapy in metastatic CRC and its correlation with survival.     

Improving Response and Outcomes for Patients With Liver-Limited Metastatic Colorectal Cancer

Long-term survival with colorectal liver metastases (CLM) usually requires surgical resection, despite considerable improvements in systemic chemotherapy that have extended median survival with metastatic colorectal cancer from 6 months to in excess of 2 years. Multidisciplinary management is now the norm in the perioperative setting, and chemotherapy has become part of an accepted treatment paradigm. Systemic and intrahepatic chemotherapy can shrink inoperable disease to the point of resection, and a combination of neoadjuvant and adjuvant chemotherapy improves disease-free survival for patients with operable CLM. A greater understanding of the biology of colorectal metastasis has revealed many new potential targets, and carefully designed clinical trials are required to investigate these and other existing biologic therapies in this setting. In this article we discuss the biology of colorectal cancer metastases, the rationale for perioperative chemotherapy, and the recent and ongoing investigation of perioperative chemotherapy in the management of CLM.     

Adjuvant Therapy After Liver Resection for Colorectal Cancer Metastasis: What is the Evidence?

Synchronous or metachronous liver metastases of colorectal origin (colorectal liver metastases, CLM), although being the expression of systemic disease, allow a curative approach for about 25% to 35% of patients. Patients presenting with CLM should receive a multimodal management in order to increase the number of patients undergoing R0 surgery and to decrease the rate of recurrence. Current data do not allow to recommend the use of locally applied chemotherapy using hepatic artery infusion after resection of CLM. Postoperative and/or preoperative systemic chemotherapy shows a trend toward a benefit regarding progression-free and overall survival, without increasing postoperative complication rates. However, all available trials failed to show a statistical significance, so that a “formal” treatment standard is not accepted and recommendations differ between no treatment and a 5-FU/oxaliplatin combination to be considered as standard of care. Future research will help in defining treatment regimens and patients selection criteria to obtain a better approach in this setting.     

Revised Modified Response Evaluation Criteria in Solid Tumors for Assessment of Response in Malignant Pleural Mesothelioma (Version 1.1)

Introduction

Malignant pleural mesothelioma poses unique difficulties in tumor measurement and response assessment; however, robust and reproducible assessment of response is critically important in the conduct, interpretation, and reporting of clinical trials.

Response of borderline resectable pancreatic cancer to neoadjuvant therapy is not reflected by radiographic indicators

BACKGROUND:

Experience with preoperative therapy for other cancers has led to an assumption that borderline resectable pancreatic cancers can be converted to resectable cancers with preoperative therapy. In this study, the authors sought to determine the rate at which neoadjuvant therapy is associated with a reduction in the size or stage of borderline resectable tumors.

METHODS:

Patients who had borderline resectable pancreatic cancer and received neoadjuvant therapy before potentially undergoing surgery at the authors' institution between 2005 and 2010 were identified. The patients' pretreatment and post‐treatment pancreatic protocol computed tomography images were rereviewed to determine changes in tumor size or stage using modified Response Evaluation Criteria in Solid Tumors (RECIST) (version 1.1) and standardized anatomic criteria.

RESULTS:

The authors identified 129 patients who met inclusion criteria. Of the 122 patients who had their disease restaged after receiving preoperative therapy, 84 patients (69%) had stable disease, 15 patients (12%) had a partial response to therapy, and 23 patients (19%) had progressive disease. Although only 1 patient (0.8%) had their disease downstaged to resectable status after receiving neoadjuvant therapy, 85 patients (66%) underwent pancreatectomy. The median overall survival duration for all 129 patients was 22 months (95% confidence interval, 14‐30 months). The median overall survival duration for the patients who underwent pancreatectomy was 33 months (95% confidence interval, 25‐41 months) and was not associated with RECIST response (P = .78).

CONCLUSIONS:

Radiographic downstaging was rare after neoadjuvant therapy, and RECIST response was not an effective treatment endpoint for patients with borderline resectable pancreatic cancer. The authors concluded that these patients should undergo pancreatectomy after initial therapy in the absence of metastases. Cancer 2012. © 2012 American Cancer Society.     

Is resection of colorectal liver metastases after a second‐line chemotherapy regimen justified?

BACKGROUND:

Patient outcomes following resection of colorectal liver metastases (CLM) after second‐line chemotherapy regimen is unknown.

METHODS:

From August 1998 to June 2009, data from 1099 patients with CLM were collected prospectively. We retrospectively analyzed outcomes of patients who underwent resection of CLM after second‐line (2 or more) chemotherapy regimens.

RESULTS:

Sixty patients underwent resection of CLM after 2 or more chemotherapy regimens. Patients had advanced CLM (mean number of CLM ± standard deviation, 4 ± 3.5; mean maximum size of CLM, 5 ± 3.2 cm) and had received 17 ± 8 cycles of preoperative chemotherapy. In 54 (90%) patients, the switch from the first regimen to another regimen was motivated by tumor progression or suboptimal radiographic response. All patients received irinotecan or oxaliplatin, and the majority (42/60 [70%]) received a monoclonal antibody (bevacizumab or cetuximab) as part of the last preoperative regimen. Postoperative morbidity and mortality rates were 33% and 3%, respectively. At a median follow‐up of 32 months, 1‐year, 3‐year, and 5‐year overall survival rates were 83%, 41%, and 22%, respectively. Median chemotherapy‐free survival after resection or completion of additional chemotherapy administered after resection was 9 months (95% confidence interval, 4‐14 months). Synchronous (vs metachronous) CLM and minor (vs major) pathologic response were independently associated with worse survival.

CONCLUSIONS:

Resection of CLM after a second‐line chemotherapy regimen was found to be safe and was associated with a modest hope for definitive cure. This approach represents a viable option in patients with advanced CLM. Cancer 2011;. © 2011 American Cancer Society.     

The differential response to chemotherapy of ovarian metastases from colorectal carcinoma

Patients and methods

All patients with metastatic (ovarian and extraovarian) CRC who underwent resection of ovarian metastases in our institution from April 1988 to August 2006 were analyzed and the response to preoperative chemotherapy was evaluated according to the RECIST criteria, and analyzed with respect to the sites of metastases (ovarian and extraovarian).

Results

The studied population consisted of 23 women. At presentation, 20 patients had symptoms. Preoperative chemotherapy resulted in tumor control of measurable extraovarian metastases in 65% of cases. In contrast, no objective tumor response of ovarian metastases was observed, disease stabilization was obtained in only 3 patients (13%), and progression or occurrence of new ovarian metastases were observed in 20 patients (87%) (p = 0.0005).With a median follow-up of 54 months [15–229], median overall survival was 30 months, and 3-year overall survival was 18%.

Conclusion

Ovarian metastases are less responsive to chemotherapy compared to other sites. As these “metastatic sanctuaries” often cause symptoms, surgical resection should always be considered for ovarian metastases, even in the case of associated extraovarian metastases.     

Assessing the optimal duration of chemotherapy in patients with colorectal liver metastases

BACKGROUND AND OBJECTIVES: Few studies have addressed the optimal duration of chemotherapy, particularly prior to liver resection for colorectal liver metastases (CLM). The purpose of this retrospective analysis was to evaluate time to maximal response in patients receiving systemic +/- hepatic arterial infusion (HAI) chemotherapy alone for the treatment of CLM. METHODS: We reviewed 35 patients with CLM on clinical trials of HAI floxuridine/dexamethasone plus systemic oxaliplatin with 5-fluorouracil/leucovorin or irinotecan (PUMP + SYSTEMIC). We retrospectively identified 35 patients with CLM who received first-line systemic 5FU/leucovorin/oxaliplatin (FOLFOX) +/- bevacizumab (SYSTEMIC) during the same time period. Measurable disease was evaluated on CT scans performed at 2-month intervals. The sum of the products of bi-dimensional tumor measurements for representative lesions was compared both to baseline imaging and between consecutive time points. RESULTS: In responders to therapy, mean cumulative tumor reduction increased from 61% at 2 months to 73% at 4 months in the PUMP + SYSTEMIC group (P < 0.01) and from 39% to 56% in the SYSTEMIC group (P < 0.01). No significant incremental tumor reduction occurred between 4 and 6 months in either group. CONCLUSIONS: In responders to preoperative therapy, surgical resection should be considered after 2-4 months, when most patients have achieved maximal response.     

Response assessment in recurrent glioblastoma treated with irinotecan-bevacizumab: comparative analysis of the Macdonald, RECIST, RANO, and RECIST + F criteria

Traditionally, the most widely used criteria for response assessment in glioblastoma have been Macdonald and the Response Evaluation Criteria In Solid Tumors (RECIST). Recently, new criteria addressing contrast enhancement and fluid-attenuated inversion recovery (FLAIR)/T2 hyperintensity have been defined (the Response Assessment in Neuro-Oncology criteria) to better evaluate the effect of antiangiogenic therapy. Whether FLAIR/T2 imaging could also be helpful to refine RECIST criteria remains unresolved. This study proposed the RECIST + F criteria and compared the 4 methods (Macdonald, RECIST, RANO, and RECIST + F) to determine their agreement in identifying response and progression of recurrent glioblastomas to irinotecan-bevacizumab. Patients with recurrent glioblastoma treated with second-line irinotecan-bevacizumab were eligible. Clinical status, corticosteroid dose, and 1-dimensional and 2-dimensional measurements of tumor contrast enhancement and FLAIR hyperintensity were retrospectively assessed. Response and progression were determined according to each set of criteria. Seventy-eight patients were included. Response rates ranged from 34.2% with RECIST + F to 44.7% with Macdonald criteria. Agreement among the 4 methods in determining response and type of progression was high (kappa statistic > 0.75). One-third of patients exhibited nonenhancing progression with stable or improved contrast enhancement. Median progression-free survival was predicted by RECIST, at 13.6 weeks; RECIST + F, 12.3; Macdonald, 12.7; and RANO, 11.7 (P = .840). Intra- and interobserver correlations were high for both contrast enhancement and FLAIR hyperintensity measurements. There was a strong concordance among the different methods in determining response and progression to irinotecan-bevacizumab. Criteria integrating FLAIR hyperintensity tended, however, to reduce response rates and progression-free survival compared with criteria considering only contrast enhancement. The 1-dimensional approach appeared to be as valid as the 2-dimensional approach.     

RECIST标准在肿癌治疗疗效评价中的应用

文章主要评价了采用RECIST标准与WHO标准在进行实体瘤疗效评价时的异同和优劣,以探求一种更简便科学的疗效评价方法.