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
Nishino M: Therapy Response Imaging in Oncology. Springer, 2020
Somarouthu B et al: Immune-related tumour response assessment criteria: a comprehensive review. Br J Radiol. 91(1084):20170457, 2018
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
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
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
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
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
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
Gonzalez-Guindalini FD et al: Assessment of liver tumor response to therapy: role of quantitative imaging. Radiographics. 33(6):1781-800, 2013
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
Lencioni R et al: Modified RECIST (mRECIST) assessment for hepatocellular carcinoma. Semin Liver Dis. 30(1):52-60, 2010
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
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Related Differential Diagnoses
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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
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
Nishino M: Therapy Response Imaging in Oncology. Springer, 2020
Somarouthu B et al: Immune-related tumour response assessment criteria: a comprehensive review. Br J Radiol. 91(1084):20170457, 2018
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
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
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
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
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
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
Gonzalez-Guindalini FD et al: Assessment of liver tumor response to therapy: role of quantitative imaging. Radiographics. 33(6):1781-800, 2013
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
Lencioni R et al: Modified RECIST (mRECIST) assessment for hepatocellular carcinoma. Semin Liver Dis. 30(1):52-60, 2010
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
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