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Imaging assessment of tumor response: past, present and future

    Asim Afaq

    Department of Radiology, Memorial Sloan-Kettering Cancer Center, New York, NY 10065, USA.

    &
    Oguz Akin

    † Author for correspondence

    Department of Radiology, Memorial Sloan-Kettering Cancer Center, New York, NY 10065, USA.

    Published Online:https://doi.org/10.2217/fon.11.38

    Anatomical response assessment criteria have been in use for decades, with the WHO guidelines being replaced by Response Evaluation Criteria in Solid Tumors (RECIST), updated in 2009 to RECIST 1.1. These methods rely on a change in size of a tumor as the main response criteria, but newer cytostatic agents tend to target tumor function at a molecular level before changing the size of a lesion. Recent modifications, such as the Choi criteria, have improved assessment by taking into account density of tumor, but all of these criteria fail to utilize functional imaging parameters, which are becoming increasingly available, including perfusion CT, perfusion MRI, diffusion-weighted imaging, magnetic resonance spectroscopy, dynamic contrast-enhanced ultrasound and combined PET/computed tomography. Developments in these modalities and standardization of imaging acquisition will help to optimize the next set of response criteria, with inclusion of multiparametric, functional modalities, evaluating tumors at the same molecular level at which they are being targeted by therapeutic agents.

    Papers of special note have been highlighted as: ▪ of interest ▪▪ of considerable interest

    Bibliography

    • Miller AB, Hoogstraten B, Staquet M et al.: Reporting results of cancer treatment. Cancer47,207–214 (1981).
    • Therasse P, Arbuck SG, Eisenhauer EA et al.: New guidelines to evaluate the response to treatment in solid tumors (RECIST guidelines). J. Natl Cancer Inst.92,205–216 (2000).▪ The original Response Evaluation Criteria in Solid Tumors (RECIST) guidelines.
    • Husband JE, Schwartz LH, Spencer J et al.: Evaluation of the response to treatment of solid tumours – a consensus statement of the International Cancer Imaging Society. Br. J. Cancer90,2256–2260 (2004).
    • Benjamin RS, Choi H, Macapinlac HA et al.: We should desist using RECIST, at least in GIST. J. Clin. Oncol.25,1760–1764 (2007).
    • Choi H: Critical issues in response evaluation on computed tomography: lessons from the gastrointestinal stromal tumor model. Curr. Oncol. Rep.7,307–311 (2005).
    • Barnacle AM, McHugh K: Limitations with the response evaluation criteria in solid tumors (RECIST) guidance in disseminated pediatric malignancy. Pediatr. Blood Cancer46,127–134 (2006).
    • Nowak AK: CT, RECIST, and malignant pleural mesothelioma. Lung Cancer49(Suppl. 1),S37–S40 (2005).
    • Eisenhauer EA, Therasse P, Bogaerts J et al.: New response evaluation criteria in solid tumours: revised RECIST guideline (version 1.1). Eur. J. Cancer45,228–247 (2009).▪▪ The key article describing the modified RECIST 1.1 guidelines.
    • Bogaerts J, Ford R, Sargent D et al.: Individual patient data analysis to assess modifications to the RECIST criteria. Eur. J. Cancer45,48–60 (2009).
    • 10  Schwartz LH, Bogaerts J, Ford R et al.: Evaluation of lymph nodes with RECIST 1.1. Eur. J. Cancer45,261–267 (2009).
    • 11  Hutchings M, Barrington SF: PET/CT for therapy response assessment in lymphoma. J. Nucl. Med.50,S21–S30 (2009).
    • 12  Hampson FA, Shaw AS: Response assessment in lymphoma. Clin. Radiol.63,125–135 (2008).
    • 13  Kim KW, Lee JM, Choi BI: Assessment of the treatment response of HCC. Abdom. Imaging DOI: 10.1007/s00261-011-9683-3 (2011) (Epub ahead of print).
    • 14  Lencioni R, Llovet JM: Modified RECIST (mRECIST) assessment for hepatocellular carcinoma. Semin. Liver Dis.30,52–60 (2010).
    • 15  Choi SH, Moon WK: Contrast-enhanced MR imaging of lymph nodes in cancer patients. Korean J. Radiol.11,383–394 (2010).
    • 16  Nishino M, Jagannathan JP, Ramaiya N et al.: Revised RECIST guideline version 1.1: what oncologists want to know and what radiologists need to know. Am. J. Roentgenol.195,281–289 (2010).▪ A useful summary on the changes in RECIST 1.1.
    • 17  Weber WA: Assessing tumor response to therapy. J. Nucl. Med.50(Suppl. 1),S1–S10 (2009).
    • 18  Zee YK, O’Connor JP, Parker GJ et al.: Imaging angiogenesis of genitourinary tumors. Nat. Rev. Urol.7,69–82 (2010).
    • 19  Choi H, Charnsangavej C, de Castro Faria S et al.: CT evaluation of the response of gastrointestinal stromal tumors after imatinib mesylate treatment: a quantitative analysis correlated with FDG PET findings. Am. J. Roentgenol.183,1619–1628 (2004).
    • 20  van der Veldt AA, Meijerink MR, van den Eertwegh AJ et al.: Choi response criteria for early prediction of clinical outcome in patients with metastatic renal cell cancer treated with sunitinib. Br. J. Cancer102,803–809 (2010).
    • 21  Gill RR, Gerbaudo VH, Sugarbaker DJ et al.: Current trends in radiologic management of malignant pleural mesothelioma. Semin. Thorac. Cardiovasc. Surg.21,111–120 (2009).
    • 22  Choi H: Response evaluation of gastrointestinal stromal tumors. Oncologist13,4–7 (2008).
    • 23  van der Veldt AA, Meijerink MR, van den Eertwegh AJ et al.: Targeted therapies in renal cell cancer: recent developments in imaging. Target Oncol.5,95–112 (2010).
    • 24  Smith AD, Lieber ML, Shah SN: Assessing tumor response and detecting recurrence in metastatic renal cell carcinoma on targeted therapy: importance of size and attenuation on contrast-enhanced CT. Am. J. Roentgenol.194,157–165 (2010).
    • 25  Dudeck O, Zeile M, Reichardt P, Pink D: Comparison of RECIST and Choi criteria for computed tomographic response evaluation in patients with advanced gastrointestinal stromal tumor treated with sunitinib. Ann. Oncol. DOI: 10.1093/annonc/mdq696 (2011) (Epub ahead of print).
    • 26  Eradat J, Abtin F, Gutierrez A, Suh R: Evaluation of treatment response after nonoperative therapy for early-stage non-small cell lung carcinoma. Cancer J.17,38–48 (2011).
    • 27  Lee HY, Lee KS, Ahn MJ et al.: New CT response criteria in non-small cell lung cancer: Proposal and application in EGFR tyrosine kinase inhibitor therapy. Lung Cancer DOI: 10.1016/j.lungcan.2010.10.019 (2010) (Epub ahead of print).
    • 28  Lee HY, Lee KS, Hwang HS et al.: Molecularly targeted therapy using bevacizumab for non-small cell lung cancer: a pilot study for the new CT response criteria. Korean J. Radiol.11,618–626 (2010).
    • 29  Padhani AR, Khan AA: Diffusion-weighted (DW) and dynamic contrast-enhanced (DCE) magnetic resonance imaging (MRI) for monitoring anticancer therapy. Target Oncol.5,39–52 (2010).
    • 30  Mannelli L, Kim S, Hajdu CH, Babb JS, Clark TW, Taouli B: Assessment of tumor necrosis of hepatocellular carcinoma after chemoembolization: diffusion-weighted and contrast-enhanced MRI with histopathologic correlation of the explanted liver. Am. J. Roentgenol.193,1044–1052 (2009).
    • 31  González Hernando C, Esteban L, Cañas T et al.: The role of magnetic resonance imaging in oncology. Clin. Transl. Oncol.12,606–613 (2010).▪ A comprehensive article focusing on different aspects of MRI, including strengths and weaknesses.
    • 32  Fernández-Guinea O, Andicoechea A, González LO et al.: Relationship between morphological features and kinetic patterns of enhancement of the dynamic breast magnetic resonance imaging and clinico-pathological and biological factors in invasive breast cancer. BMC Cancer10,8 (2010).
    • 33  Matsuoka S, Hunsaker AR, Gill RR et al.: Functional MR imaging of the lung. Magn. Reson. Imaging Clin. N. Am.16,275–289 (2008).
    • 34  Beloueche-Babari M, Chung YL, Al-Saffar NM, Falck-Miniotis M, Leach MO: Metabolic assessment of the action of targeted cancer therapeutics using magnetic resonance spectroscopy. Br. J. Cancer102,1–7 (2010).
    • 35  Dhermain FG, Hau P, Lanfermann H et al.: Advanced MRI and PET imaging for assessment of treatment response in patients with gliomas. Lancet Neurol.9,906–920 (2010).
    • 36  Glunde K, Bhujwalla ZM: Metabolic tumor imaging using magnetic resonance spectroscopy. Semin. Oncol.38,26–41 (2011).
    • 37  Koh DM, Collins DJ: Diffusion-weighted MRI in the body: applications and challenges in oncology. Am. J. Roentgenol.188,1622–1635 (2007).
    • 38  Arlinghaus LR, Li X, Levy M et al.: Current and future trends in magnetic resonance imaging assessments of the response of breast tumors to neoadjuvant chemotherapy. J. Oncol. (2010) PII: 919620 (2010).
    • 39  Afaq A, Andreou A, Koh DM: Diffusion-weighted magnetic resonance imaging for tumour response assessment: why, when and how? Cancer Imaging10,S179–S88 (2010).
    • 40  Fenchel M, Konaktchieva M, Weisel K et al.: Response assessment in patients with multiple myeloma during antiangiogenic therapy using arterial spin labeling and diffusion-weighted imaging: a feasibility study. Acad. Radiol.17,1326–1333 (2010).
    • 41  Koh DM, Blackledge M, Collins DJ et al.: Reproducibility and changes in the apparent diffusion coefficients of solid tumours treated with combretastatin A4 phosphate and bevacizumab in a two-centre Phase I clinical trial. Eur. Radiol.19,2728–2738 (2009).
    • 42  Jain R: Perfusion CT imaging of brain tumors: an overview. Am. J. Neuroradiol. DOI: 10.3174/ajnr.A2263 (2010) (Epub ahead of print).
    • 43  Pollard RE, Larson RF: Dynamic contrast-enhanced computed tomography for the quantification of tumor response to vasoactive agents in a rat tumor model: preliminary results. Contrast Media Mol. Imaging6(1),28–34 (2011).
    • 44  Choi SH, Chung JW, Kim HC et al.: The role of perfusion CT as a follow-up modality after transcatheter arterial chemoembolization: an experimental study in a rabbit model. Invest. Radiol.45,427–436 (2010).
    • 45  Hegenscheid K, Behrendt N, Rosenberg C et al.: Assessing early vascular changes and treatment response after laser-induced thermotherapy of pulmonary metastases with perfusion CT: initial experience. Am. J. Roentgenol.194,1116–1123 (2010).
    • 46  Squillaci E, Manenti G, Cicciò C et al.: Perfusion-CT monitoring of cryo-ablated renal cells tumors. J. Exp. Clin. Cancer Res.28,138 (2009).
    • 47  Wu GY, Ghimire P: Perfusion computed tomography in colorectal cancer: protocols, clinical applications and emerging trends. World J. Gastroenterol.15,3228–3231 (2009).
    • 48  Goh V, Dattani M, Farwell J et al.: Radiation dose from volumetric helical perfusion CT of the thorax, abdomen or pelvis. Eur. Radiol.21(5),974–981 (2010).
    • 49  Bellomi M, Viotti S, Preda L, D’Andrea G, Bonello L, Petralia G: Perfusion CT in solid body-tumours. Part II: clinical applications and future development. Radiol. Med.115,858–874 (2010).
    • 50  Kong WT, Zhang WW, Guo HQ et al.: Application of contrast-enhanced ultrasonography after radiofrequency ablation for renal cell carcinoma: is it sufficient for assessment of therapeutic response? Abdom. Imaging DOI: 10.1007/s00261-010-9665-x (2010) (Epub ahead of print).
    • 51  Lassau N, Koscielny S, Chami L et al.: Advanced hepatocellular carcinoma: early evaluation of response to bevacizumab therapy at dynamic contrast-enhanced US with quantification – preliminary results. Radiology258(1),291–300 (2011).
    • 52  Lassau N, Chami L, Koscielny S et al.: Quantitative functional imaging by dynamic contrast enhanced ultrasonography (DCE-US) in GIST patients treated with masatinib. Invest. New Drugs DOI: 10.1007/s10637-010-9592-2 (2010) (Epub ahead of print).
    • 53  Lassau N, Koscielny S, Albiges L et al.: Metastatic renal cell carcinoma treated with sunitinib: early evaluation of treatment response using dynamic contrast-enhanced ultrasonography. Clin. Cancer Res.16,1216–1225 (2010).
    • 54  Lassau N, Chami L, Chebil M et al.: Dynamic contrast-enhanced ultrasonography (DCE-US) and anti-angiogenic treatments. Discov. Med.11,18–24 (2011).
    • 55  Wahl RL, Jacene H, Kasamon Y et al.: From RECIST to PERCIST: evolving considerations for PET response criteria in solid tumors. J. Nucl. Med.50,S122–S150 (2009).▪ Detailed description of potential response assessment criteria for PET.
    • 56  Zaidi H, Montandon ML, Alavi A: The clinical role of fusion imaging using PET, CT, and MR imaging. Magn. Reson. Imaging Clin. N. Am.18,133–149 (2010).
    • 57  Marten K, Auer F, Schmidt S, Kohl G, Rummey EJ, Engelke C: Inadequacy of manual measurements compared to automated CT volumetry in assessment of treatment response of pulmonary metastases using RECIST criteria. Eur. Radiol.16,781–790 (2006).
    • 58  Keil S, Behrendt FF, Stanzel S et al.: Semi-automated measurement of hyperdense, hypodense and heterogeneous hepatic metastasis on standard MDCT slices. Comparison of semiautomated and manual measurement of RECIST and WHO criteria. Eur. Radiol.18,2456–2465 (2008).
    • 59  Fabel M, von Tengg-Kobligk H, Giesel FL et al.: Semi-automated volumetric analysis of lymph node metastases in patients with malignant melanoma stage III/IV – a feasibility study. Eur. Radiol.18,1114–1122 (2008).
    • 60  Ertl-Wagner BB, Blume JD, Peck D et al.: Reliability of tumor volume estimation from MR images in patients with malignant glioma. Results from the American College of Radiology Imaging Network (ACRIN) 6662 trial. Eur. Radiol.19,599–609 (2009).
    • 61  van Persijn van Meerten EL, Gelderblom H, Bloem JL: RECIST revised: implications for the radiologist. A review article on the modified RECIST guideline. Eur. Radiol.20,1456–1467 (2010).