Abstract
Objective We propose a computer-aided method to assess response to drug treatment, using CT imaging-based volumetric and density measures in patients with gastroenteropancreatic neuroendocrine tumors (GEP-NETs) and diffuse liver metastases. Methods Twenty-five patients with GEP-NETs with diffuse liver metastases were enrolled. Pre- and posttreatment CT examinations were retrospectively analyzed. Total tumor volume (volume) and mean volumetric tumor density (density) were calculated based on tumor segmentation on CT images. The maximum axial diameter (tumor size) for each target tumor was measured on pre- and posttreatment CT images according to Response Evaluation Criteria In Solid Tumors (RECIST). Progression-free survival (PFS) for each patient was measured and recorded. Results Correlation analysis showed inverse correlation between change of volume and density (Δ(V + D)), change of volume (ΔV), and change of tumor size (ΔS) with PFS (r = −0.653, P=0.001; r = −0.617, P=0.003; r = −0.548, P=0.01, respectively). There was no linear correlation between ΔD and PFS (r = −0.226, P=0.325). Conclusion The changes of volume and density derived from CT images of all lesions showed a good correlation with PFS and may help assess treatment response.
Highlights
Neuroendocrine tumors (NETs) may a ect di erent organs of the human body, such as the thymus, lungs, pancreas, and gastrointestinal tract [1, 2]. e estimated annual incidence of clinically signi cant NETs is 5.25 per 100,000 [3]
Many treatment strategies can be applied to GEP-NETs with di use liver metastasis, of which medications play an important role in the management of unresectable liver metastases
Of 18 patients with stable disease, 2 patients demonstrated decreased total tumor volume and mean volumetric tumor density: the total tumor volume decreased by 88.7% and 74.6%, and the mean volumetric tumor density decreased by 3.0% and 27.8%, respectively. 2 patients demonstrated increased total tumor volume and decreased mean volumetric tumor density, the total tumor volume increased by 57.9% and 43.5%, and the mean volumetric tumor density decreased by 14.5% and 13.1%, respectively. 2 patients with decreased total tumor volume and increased mean volumetric tumor density, the total tumor volume decreased by 28.7% and 27.5%, and the mean volumetric tumor density increased by 17.8% and 5.4%, respectively. 12 showed increased total tumor volume and mean volumetric tumor density
Summary
We propose a computer-aided method to assess response to drug treatment, using CT imaging-based volumetric and density measures in patients with gastroenteropancreatic neuroendocrine tumors (GEP-NETs) and di use liver metastases. Twentyve patients with GEP-NETs with di use liver metastases were enrolled. E maximum axial diameter (tumor size) for each target tumor was measured on pre- and posttreatment CT images according to Response Evaluation Criteria In Solid Tumors (RECIST). Correlation analysis showed inverse correlation between change of volume and density (Δ(V + D)), change of volume (ΔV), and change of tumor size (ΔS) with PFS (r −0.653, P 0.001; r −0.617, P 0.003; r −0.548, P 0.01, respectively). E changes of volume and density derived from CT images of all lesions showed a good correlation with PFS and may help assess treatment response Conclusion. e changes of volume and density derived from CT images of all lesions showed a good correlation with PFS and may help assess treatment response
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