Is There a Limitation of RECIST Criteria in Prediction of Pathological Response, in Head and Neck Cancers, to Postinduction Chemotherapy?

V Patil,S Juvekar,Supreeta Arya,A Dongre,Aswari Patil,A Joshi,Vamshi Muddu Krishna,D Chaukar,B Bhosale,V Noronha,A K Dcruz,K Prabhash,Gauri Pantvaidya,Pankaj Chaturvedi

doi:10.1155/2013/259154

Abstract

This study studied the coorelation between radiological response to induction chemotherapy and acheivement of pCR or near pCR. It was a retrospective analysis in which all patients who received NACT from 2008 till april 2012 were subjected to inclusion criteria. Coorelation analysis was performed between CR + PR and acheivement of pCR or near pCR. Twenty four patients were identified.The primary site of tumor was oral cavity in 19 patients (79.2%), maxilla in 2 patients (4.2%), laryngopharynx in 2 patients (4.2%) and oropharynx in 1 patient (4.2%). The clinical stage was stage IVA in 16 patients ( 66.7%) and IVB in 8 patients (33.3%). The overall response rates ie a combination of CR and PR was seen in 11patients (45.8%). The pCR was seen in 15 patients (62.5%) and rest had near pCR. There was no linear coorelation between radiological size decrement and tumor response. On coorelation analysis the spearman correlation coefficent was −0.039 (P = 0.857). This suggest that presently used radiological response criterias for response assesment in head and neck cancers severly limit our ability to identify patients who would have pCR or near pCR.

Highlights

RECIST criteria have been widely used for response assessment both in general clinical practice and clinical trials [1]
Analogous to the RECIST, a perceived decline of more than 30% but less than 100% was termed as PRp, 100% decline was termed as CRp, a reduction not more than 30% or a progression in size no more than 20% was termed as SDp, and a progression in size of more than 20% was termed as PDp
CRp was seen in 1 patient (4.5%), PRp was seen in 16 patients (72.7%), and SDp was seen in 5 patients (22.8%)

Summary

Introduction

RECIST (response evaluation criteria in solid tumors) criteria have been widely used for response assessment both in general clinical practice and clinical trials [1]. RECIST criteria are easier to apply in well-defined lesions, as in metastatic nodules [3, 4]. The application of these criteria in complex, irregularly shaped tumors like head and neck cancers might be more difficult. This assumes significance in situations where response to initial therapy would dictate the treatment protocol, especially in patients being treated with curative intent [5,6,7]. Prasad et al have shown that the treatment response was graded differently based on volumetric measurement as opposed to unidimensional imaging of tumor burden in head and neck cancers [8]

Methods

Results

Discussion

Conclusion