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Problems in the assessment of treatment response

Problems in the assessment of treatment response radiologists, pathologists, surgeons, physicians and no. 361: 225. paramedical staff, as well as the support of administra- [4] Kalbhen CL, Yetter EM, Olson MC, Posniak HV, Aranha GV. tors and clerical staff. Notes, films and slides must all be Assessing the resectability of pancreatic carcinoma: the value of available and in this forum clinical and pathological reinterpreting abdominal CT performed at other institutions. information is often brought to light which resolves Am J Roentgenol 1998; 171: 1571–6. problems, downgrades the clinical impact of radiological [5] Gollub MJ, Panicek DM, Bach AM, Penalver A, Castellino RA. Clinical importance of reinterpretation of body CT scans uncertainty or else discussion helps to form management obtained elsewhere in patients referred for care at a tertiary or investigation plans to respond to this. There is little cancer center. Radiology 1999; 210: 109–12. reported research on the value of such meetings but such [6] Leung DPY, Dixon AK. Clinico-radiological meetings: are as it is the data are clear. Clinicians place high value on they worthwhile? Clin Radiol 1992; 46: 279–80. time spent within such meetings and they are time- [7] Dalla Palma L, Stacul F, Meduri S, Te Geitung J. [6,7] effective for radiologists . Relationships between radiologists and clinicians: results from three surveys. Clin Radiol 2000; 55: 602–5. The digital object identifier for this article is: 10.1102/ References 1470-7330.2001.018 [1] Loughrey GJ, Carrington BM, Anderson H, Dobson MJ, Lo Ying Ping F. The value of specialist oncological radiology review of cross-sectional imaging. Clin Radiol 1999; 54: 149–54. Ovarian cancer — difficulties in monitoring response D Michael King Consultant Radiologist, The Royal Marsden NHS Trust, Fulham Road, London SW3 6JJ, UK The imaging of malignant disease involves tumour size of a single lesion might be at variance with favour- diagnosis, staging, measurement of response and identi- able change elsewhere. This could lead to an incorrect fication of complications. Increasingly, oncologic radi- conclusion that therapy was ineffective. It has also ologists are expected to provide objective assessment of become clear that methods for evaluating change in the change in masses, on serial studies, in order to validate size of measurable lesions have not always been univer- response or resistance to new chemotherapeutic agents. sally applied and different observers and even centres In some cancer centres follow-up examinations make up could employ different regimes. Husband, Gwyther and [2] over 75% of computed tomography (CT) activity. Rankin highlighted these features in 1999 when they Objective assessment on CT depends on a somewhat described the problems of bi-dimensional measurements simplistic assumption that those masses that increase in of 3-dimensional masses, as well as the difficulties posed size define disease progression, whereas reduction in by tumour necrosis and calcification. tumour size indicates a favourable therapeutic impact. In June 1999 a revised version of WHO criteria under The 1979 WHO Handbook and the 1981 paper by Miller the heading ‘Response Evaluation Criteria in Solid [1] [3] et al. identified criteria for bi-dimensional measure- Tumours (RECIST criteria)’ was published, based on ments of tumour masses and established the classifica- the assessment of up to 10 target lesions, the sum of tion of Complete Response (CR), Partial Response whose longest diameters define the baseline measure- (PR), Stable Disease (SD) and Progressive Disease ment. The stimulus for this finite objective measurement (PD). It has became apparent, however, during the emanates from the licensing authorities, whose require- application of these criteria that assessments based on ments define phase II drug assessment protocols for the bi-dimensional measurements of one or two marker pharmaceutical industry. RECIST criteria require the lesions could result in misleading conclusions, particu- identification up to 10 solid, well-marginated nodules larly in respect of progressive disease where increasing and their repeated identification and assessment of http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Cancer Imaging Springer Journals

Problems in the assessment of treatment response

Spencer, John
Cancer Imaging , Volume 2 (1) – May 5, 2015
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References (10)

Publisher
Springer Journals
Copyright
Copyright © 2001 by International Cancer Imaging Society
Subject
Medicine & Public Health; Imaging / Radiology; Cancer Research; Oncology
eISSN
1470-7330
DOI
10.1102/1470-7330.2001.018
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Abstract

radiologists, pathologists, surgeons, physicians and no. 361: 225. paramedical staff, as well as the support of administra- [4] Kalbhen CL, Yetter EM, Olson MC, Posniak HV, Aranha GV. tors and clerical staff. Notes, films and slides must all be Assessing the resectability of pancreatic carcinoma: the value of available and in this forum clinical and pathological reinterpreting abdominal CT performed at other institutions. information is often brought to light which resolves Am J Roentgenol 1998; 171: 1571–6. problems, downgrades the clinical impact of radiological [5] Gollub MJ, Panicek DM, Bach AM, Penalver A, Castellino RA. Clinical importance of reinterpretation of body CT scans uncertainty or else discussion helps to form management obtained elsewhere in patients referred for care at a tertiary or investigation plans to respond to this. There is little cancer center. Radiology 1999; 210: 109–12. reported research on the value of such meetings but such [6] Leung DPY, Dixon AK. Clinico-radiological meetings: are as it is the data are clear. Clinicians place high value on they worthwhile? Clin Radiol 1992; 46: 279–80. time spent within such meetings and they are time- [7] Dalla Palma L, Stacul F, Meduri S, Te Geitung J. [6,7] effective for radiologists . Relationships between radiologists and clinicians: results from three surveys. Clin Radiol 2000; 55: 602–5. The digital object identifier for this article is: 10.1102/ References 1470-7330.2001.018 [1] Loughrey GJ, Carrington BM, Anderson H, Dobson MJ, Lo Ying Ping F. The value of specialist oncological radiology review of cross-sectional imaging. Clin Radiol 1999; 54: 149–54. Ovarian cancer — difficulties in monitoring response D Michael King Consultant Radiologist, The Royal Marsden NHS Trust, Fulham Road, London SW3 6JJ, UK The imaging of malignant disease involves tumour size of a single lesion might be at variance with favour- diagnosis, staging, measurement of response and identi- able change elsewhere. This could lead to an incorrect fication of complications. Increasingly, oncologic radi- conclusion that therapy was ineffective. It has also ologists are expected to provide objective assessment of become clear that methods for evaluating change in the change in masses, on serial studies, in order to validate size of measurable lesions have not always been univer- response or resistance to new chemotherapeutic agents. sally applied and different observers and even centres In some cancer centres follow-up examinations make up could employ different regimes. Husband, Gwyther and [2] over 75% of computed tomography (CT) activity. Rankin highlighted these features in 1999 when they Objective assessment on CT depends on a somewhat described the problems of bi-dimensional measurements simplistic assumption that those masses that increase in of 3-dimensional masses, as well as the difficulties posed size define disease progression, whereas reduction in by tumour necrosis and calcification. tumour size indicates a favourable therapeutic impact. In June 1999 a revised version of WHO criteria under The 1979 WHO Handbook and the 1981 paper by Miller the heading ‘Response Evaluation Criteria in Solid [1] [3] et al. identified criteria for bi-dimensional measure- Tumours (RECIST criteria)’ was published, based on ments of tumour masses and established the classifica- the assessment of up to 10 target lesions, the sum of tion of Complete Response (CR), Partial Response whose longest diameters define the baseline measure- (PR), Stable Disease (SD) and Progressive Disease ment. The stimulus for this finite objective measurement (PD). It has became apparent, however, during the emanates from the licensing authorities, whose require- application of these criteria that assessments based on ments define phase II drug assessment protocols for the bi-dimensional measurements of one or two marker pharmaceutical industry. RECIST criteria require the lesions could result in misleading conclusions, particu- identification up to 10 solid, well-marginated nodules larly in respect of progressive disease where increasing and their repeated identification and assessment of

Journal

Cancer Imaging – Springer Journals

Published: May 5, 2015

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