Abstract
Two sets of response criteria using PET are currently available to monitor metabolic changes in solid tumors: the criteria developed by the European Organization for Research and Treatment of Cancer (EORTC criteria) and the PET Response Criteria in Solid Tumors (PERCIST). We conducted this pooled study to investigate the strength of agreement between the EORTC criteria and PERCIST in the assessment of tumor response. We surveyed MEDLINE, EMBASE and PUBMED for articles with terms of the EORTC criteria and PERCIST between 2009 and January 2016. We searched for all the references of relevant articles and reviews using the ‘related articles’ feature in the PUBMED. There were six articles with the data on the comparison of the EORTC criteria and PERCIST. A total of 348 patients were collected; 190 (54.6%) with breast cancer, 81 with colorectal cancer, 45 with lung cancer, 14 with basal cell carcinoma in the skin, 12 with stomach cancer, and 6 with head and neck cancer. The agreement of tumor response between the EORTC criteria and PERCIST was excellent (k = 0.946). Of 348 patients, only 12 (3.4%) showed disagreement between the two criteria in the assessment of tumor response. The shift of tumor response between the EORTC criteria and PERCIST occurred mostly in patients with PMR and SMD. The estimated overall response rates were not significantly different between the two criteria (72.7% by EORTC vs. 73.6% by PERCIST). In conclusion, this pooled analysis demonstrates that the EORTC criteria and PERCIST showed almost perfect agreement in the assessment of tumor response.
Highlights
The WHO guidelines [1] and Response Evaluation Criteria in Solid Tumors (RECIST) [2] are the most commonly used criteria to assess response to anticancer treatment in solid tumors
Two sets of response criteria using Positron emission tomography (PET) are currently available to monitor metabolic changes in solid tumors: the criteria developed by the European Organization for Research and Treatment of Cancer (EORTC criteria) and the PET Response Criteria in Solid Tumors (PERCIST)
A total of 348 patients with various solid tumors were collected from the six studies; 190 (54.6%) with breast cancer [14, 16, 17], 81 (23.3%) with colorectal cancer [15, 17], 45 (12.9%) with lung cancer [13, 17], 14 with basal cell carcinoma in the skin [12], 12 with stomach cancer [17], and 6 with head and neck cancer [17] (Table 1)
Summary
The WHO guidelines [1] and Response Evaluation Criteria in Solid Tumors (RECIST) [2] are the most commonly used criteria to assess response to anticancer treatment in solid tumors These criteria depending on anatomic changes based on computed tomography (CT) or magnetic resonance imaging (MRI) have limitations in tumors with obscure margins, cystic lesion, or scar tissue. It may be difficult to distinguish necrotic tissue or fibrotic scar from residual tumor by anatomical images [3] Because these criteria had been developed only for patients receiving cytotoxic treatment, neither of the two criteria has been validated in patients treated with targeted agents that tend to induce necrotic or cystic change, not tumor shrinkage, in solid tumors [4]. FDG PET responses have been more significantly correlated with survival than those assessed by CT or MRI [9]
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