Abstract
BackgroundThe Response Evaluation Criteria in Solid Tumors (RECIST) are the current standard for evaluating disease progression or therapy response in patients with solid tumors. RECIST 1.1 calls for axial, longest-diameter (or perpendicular short axis of lymph nodes) measurements of a maximum of five tumors, which limits clinicians’ ability to adequately measure disease burden, especially in patients with irregularly shaped tumors. This is especially problematic in chordoma, a disease for which RECIST does not always adequately capture disease burden because chordoma tumors are typically irregularly shaped and slow-growing. Furthermore, primary chordoma tumors tend to be adjacent to vital structures in the skull or sacrum that, when compressed, lead to significant clinical consequences.MethodsVolumetric segmentation is a newer technology that allows tumor burden to be measured in three dimensions on either MR or CT. Here, we compared the ability of RECIST measurements and tumor volumes to predict clinical outcomes in a cohort of 21 chordoma patients receiving immunotherapy.ResultsThere was a significant difference in radiologic time to progression Kaplan-Meier curves between clinical outcome groups using volumetric segmentation (P = 0.012) but not RECIST (P = 0.38). In several cases, changes in volume were earlier and more sensitive reflections of clinical status.ConclusionRECIST is a useful evaluation method when obvious changes are occurring in patients with chordoma. However, in many cases, RECIST does not detect small changes, and volumetric assessment was capable of detecting changes and predicting clinical outcome earlier than RECIST. Although this study was small and retrospective, we believe our results warrant further research in this area.
Highlights
The Response Evaluation Criteria in Solid Tumors (RECIST) are the current standard for evaluating disease progression or therapy response in patients with solid tumors
RECIST 1.1, which calls for measurement of the longest diameter of the tumor, does not adequately represent the size of nonspherical lesions, nor does it reflect anisotropic changes in tumor size
This research was conducted on images collected during two clinical trials, which were run in compliance with the Helsinki Declaration and were approved by the Center for Cancer Research, National Cancer Institute Institutional Review Board
Summary
The Response Evaluation Criteria in Solid Tumors (RECIST) are the current standard for evaluating disease progression or therapy response in patients with solid tumors. RECIST 1.1, which calls for measurement of the longest diameter of the tumor (or perpendicular short axis of malignant lymph nodes), does not adequately represent the size of nonspherical lesions, nor does it reflect anisotropic changes in tumor size. It accounts for only five tumors per patient, with a maximum of two tumors per organ system. Segmentation consists of object recognition and delineation for the purpose of extracting quantitative information, such as tumor volume [2] and density [3] It has many advantages over one-dimensional RECIST measurements, including the capability to assess all measureable lesions instead of just five lesions per patient. Volumetric segmentation has been shown to be reproducible, even in complex intracranial tumors [9]
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