link
Bookmarks
Gastrointestinal
Diagnosis
Abdominal Manifestations of Systemic Conditions
Malignant Neoplasms
Treatment Response Assessment
Treatment Response Assessment
Atif Zaheer, MD
To access 4,300 diagnoses written by the world's leading experts in radiology.Try it free - 15 days
1
0
0
0

KEY FACTS

  • Terminology

    • Imaging

      TERMINOLOGY

      • Definitions

        • Common terminology to describe tumor response to therapy

      • WHO Criteria

        • Assesses tumor burden
        • Tumor size measured by multiplying longest diameter (LD) of tumor by its greatest perpendicular diameter
        • Limitations
          • Reproducibility
          • Only tumor size used as metric and does not take into account tumor necrosis
          • No standard criteria for minimum or maximum number of lesions

      • Response Evaluation Criteria in Solid Tumors (RECIST) 1.0

        • Lesions must be ≥ 2 cm with radiography or ≥ 1 cm with CT
        • 1-dimensional measurement that calculates sum of LDs of all target tumor lesions
        • ≥ 5 lesions/organ and 10 lesions total can be measured
        • WHO and RECIST 1.0 criteria can detect response to treatment as early as 7-8 months
        • Limitations
          • Reproducibility
          • Differentiation of viable tumor from necrosis not done
          • Infiltrative tumor not measured accurately because of ill-defined margins
          • Not well defined for lymph node evaluation

      • RECIST 1.1

        • Total number of assessed lesions: 2/organ and total of 5
        • Lymph nodes with short axis ≥ 15 mm as target lesion
        • New guideline to use F-18 FDG PET for detecting new lesions
        • Limitations
          • Unidimensional measurement and considers all tumors to be spherical
          • Subjectivity
          • Tumor necrosis not addressed as part of response criteria
            • Issue especially with immunotherapy
          • No specific phase defined after IV contrast agent injection for lesion measurement

      • Modified CT Response Evaluation Criteria (Choi Criteria)

        • Developed in 2007 to assess GI stromal tumor response to imatinib treatment
        • Used for hypervascular tumors like GI stromal tumor (GIST), hepatocellular carcinoma (HCC)
        • May be superior to WHO and RECIST in predicting overall survival in HCC patients treated by Sorafenib and transarterial radioembolization
        • CT attenuation coefficient is measured by region of interest placement on lesions during portal venous phase

      • Response Evaluation Criteria in Cancer of Liver (RECICL)

        • RECICL evaluate HCC response to locoregional therapy (LRT)
        • Posttreatment assessment by imaging is recommended 1 month after transarterial chemoembolization (TACE) and 6 months after transarterial radioembolization
        • Quantifies necrotic parts using bidimensional measurements like WHO

      • European Association for Study of Liver (EASL) Criteria

        • To address limitations of size-based criteria in assessing tumor response to LRT
        • Like WHO bidimensional measurements but only focuses on viable tumor tissue (sum of arterially enhancing part of tumor)
        • May detect tumor response as early as 1.6 months after therapy
        • Can predict overall survival between 2 and 3 months after TACE

      • Modified RECIST (mRECIST)

        • Combined some features of EASL criteria with RECIST criteria
        • LD of enhancing part of tumor in arterial phase of CT or MR without taking into account necrotic part
        • Poorly or atypically enhancing HCC cannot be selected as target lesions
        • Assesses tumor response as early as 2 months

      • Immune-Related Criteria

        • Used for treatment response after immune therapies
        • Overall tumor burden at baseline is determined as sum of product of diameters for all index lesions
        • Initial enlargement and development of new lesions not considered progressive disease (due to T-cell infiltration)

      IMAGING

      • CT Findings

        • MR Findings

          • Nuclear Medicine Findings

            Selected References

            1. Nishino M: Therapy Response Imaging in Oncology. Springer, 2020
            2. Somarouthu B et al: Immune-related tumour response assessment criteria: a comprehensive review. Br J Radiol. 91(1084):20170457, 2018
            3. Sung PS et al: 18F-fluorodeoxyglucose uptake of hepatocellular carcinoma as a prognostic predictor in patients with sorafenib treatment. Eur J Nucl Med Mol Imaging. 45(3):384-91, 2018
            4. Lencioni R et al: Objective response by mRECIST as a predictor and potential surrogate end-point of overall survival in advanced HCC. J Hepatol. 66(6):1166-72, 2017
            5. Shirota N et al: Intravoxel incoherent motion MRI as a biomarker of sorafenib treatment for advanced hepatocellular carcinoma: a pilot study. Cancer Imaging. 16:1, 2016
            6. Syha R et al: Parenchymal blood volume assessed by C-arm-based computed tomography in immediate posttreatment evaluation of drug-eluting bead transarterial chemoembolization in hepatocellular carcinoma. Invest Radiol. 51(2):121-6, 2016
            7. Yang Z et al: Application of single voxel 1H magnetic resonance spectroscopy in hepatic benign and malignant lesions. Med Sci Monit. 22:5003-10, 2016
            8. Bonekamp D et al: Interobserver agreement of semi-automated and manual measurements of functional MRI metrics of treatment response in hepatocellular carcinoma. Eur J Radiol. 83(3):487-96, 2014
            9. Gonzalez-Guindalini FD et al: Assessment of liver tumor response to therapy: role of quantitative imaging. Radiographics. 33(6):1781-800, 2013
            10. Kudo M et al: Response Evaluation Criteria in Cancer of the Liver (RECICL) proposed by the Liver Cancer Study Group of Japan (2009 revised version). Hepatol Res. 40(7):686-92, 2010
            11. Lencioni R et al: Modified RECIST (mRECIST) assessment for hepatocellular carcinoma. Semin Liver Dis. 30(1):52-60, 2010
            12. Choi H et al: Correlation of computed tomography and positron emission tomography in patients with metastatic gastrointestinal stromal tumor treated at a single institution with imatinib mesylate: proposal of new computed tomography response criteria. J Clin Oncol. 25(13):1753-9, 2007
            Related Anatomy
            Loading...
            Related Differential Diagnoses
            Loading...
            References
            Tables

            Tables

            KEY FACTS

            • Terminology

              • Imaging

                TERMINOLOGY

                • Definitions

                  • Common terminology to describe tumor response to therapy

                • WHO Criteria

                  • Assesses tumor burden
                  • Tumor size measured by multiplying longest diameter (LD) of tumor by its greatest perpendicular diameter
                  • Limitations
                    • Reproducibility
                    • Only tumor size used as metric and does not take into account tumor necrosis
                    • No standard criteria for minimum or maximum number of lesions

                • Response Evaluation Criteria in Solid Tumors (RECIST) 1.0

                  • Lesions must be ≥ 2 cm with radiography or ≥ 1 cm with CT
                  • 1-dimensional measurement that calculates sum of LDs of all target tumor lesions
                  • ≥ 5 lesions/organ and 10 lesions total can be measured
                  • WHO and RECIST 1.0 criteria can detect response to treatment as early as 7-8 months
                  • Limitations
                    • Reproducibility
                    • Differentiation of viable tumor from necrosis not done
                    • Infiltrative tumor not measured accurately because of ill-defined margins
                    • Not well defined for lymph node evaluation

                • RECIST 1.1

                  • Total number of assessed lesions: 2/organ and total of 5
                  • Lymph nodes with short axis ≥ 15 mm as target lesion
                  • New guideline to use F-18 FDG PET for detecting new lesions
                  • Limitations
                    • Unidimensional measurement and considers all tumors to be spherical
                    • Subjectivity
                    • Tumor necrosis not addressed as part of response criteria
                      • Issue especially with immunotherapy
                    • No specific phase defined after IV contrast agent injection for lesion measurement

                • Modified CT Response Evaluation Criteria (Choi Criteria)

                  • Developed in 2007 to assess GI stromal tumor response to imatinib treatment
                  • Used for hypervascular tumors like GI stromal tumor (GIST), hepatocellular carcinoma (HCC)
                  • May be superior to WHO and RECIST in predicting overall survival in HCC patients treated by Sorafenib and transarterial radioembolization
                  • CT attenuation coefficient is measured by region of interest placement on lesions during portal venous phase

                • Response Evaluation Criteria in Cancer of Liver (RECICL)

                  • RECICL evaluate HCC response to locoregional therapy (LRT)
                  • Posttreatment assessment by imaging is recommended 1 month after transarterial chemoembolization (TACE) and 6 months after transarterial radioembolization
                  • Quantifies necrotic parts using bidimensional measurements like WHO

                • European Association for Study of Liver (EASL) Criteria

                  • To address limitations of size-based criteria in assessing tumor response to LRT
                  • Like WHO bidimensional measurements but only focuses on viable tumor tissue (sum of arterially enhancing part of tumor)
                  • May detect tumor response as early as 1.6 months after therapy
                  • Can predict overall survival between 2 and 3 months after TACE

                • Modified RECIST (mRECIST)

                  • Combined some features of EASL criteria with RECIST criteria
                  • LD of enhancing part of tumor in arterial phase of CT or MR without taking into account necrotic part
                  • Poorly or atypically enhancing HCC cannot be selected as target lesions
                  • Assesses tumor response as early as 2 months

                • Immune-Related Criteria

                  • Used for treatment response after immune therapies
                  • Overall tumor burden at baseline is determined as sum of product of diameters for all index lesions
                  • Initial enlargement and development of new lesions not considered progressive disease (due to T-cell infiltration)

                IMAGING

                • CT Findings

                  • MR Findings

                    • Nuclear Medicine Findings

                      Selected References

                      1. Nishino M: Therapy Response Imaging in Oncology. Springer, 2020
                      2. Somarouthu B et al: Immune-related tumour response assessment criteria: a comprehensive review. Br J Radiol. 91(1084):20170457, 2018
                      3. Sung PS et al: 18F-fluorodeoxyglucose uptake of hepatocellular carcinoma as a prognostic predictor in patients with sorafenib treatment. Eur J Nucl Med Mol Imaging. 45(3):384-91, 2018
                      4. Lencioni R et al: Objective response by mRECIST as a predictor and potential surrogate end-point of overall survival in advanced HCC. J Hepatol. 66(6):1166-72, 2017
                      5. Shirota N et al: Intravoxel incoherent motion MRI as a biomarker of sorafenib treatment for advanced hepatocellular carcinoma: a pilot study. Cancer Imaging. 16:1, 2016
                      6. Syha R et al: Parenchymal blood volume assessed by C-arm-based computed tomography in immediate posttreatment evaluation of drug-eluting bead transarterial chemoembolization in hepatocellular carcinoma. Invest Radiol. 51(2):121-6, 2016
                      7. Yang Z et al: Application of single voxel 1H magnetic resonance spectroscopy in hepatic benign and malignant lesions. Med Sci Monit. 22:5003-10, 2016
                      8. Bonekamp D et al: Interobserver agreement of semi-automated and manual measurements of functional MRI metrics of treatment response in hepatocellular carcinoma. Eur J Radiol. 83(3):487-96, 2014
                      9. Gonzalez-Guindalini FD et al: Assessment of liver tumor response to therapy: role of quantitative imaging. Radiographics. 33(6):1781-800, 2013
                      10. Kudo M et al: Response Evaluation Criteria in Cancer of the Liver (RECICL) proposed by the Liver Cancer Study Group of Japan (2009 revised version). Hepatol Res. 40(7):686-92, 2010
                      11. Lencioni R et al: Modified RECIST (mRECIST) assessment for hepatocellular carcinoma. Semin Liver Dis. 30(1):52-60, 2010
                      12. Choi H et al: Correlation of computed tomography and positron emission tomography in patients with metastatic gastrointestinal stromal tumor treated at a single institution with imatinib mesylate: proposal of new computed tomography response criteria. J Clin Oncol. 25(13):1753-9, 2007