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Fu C, Dong J, Zhang J, Li X, Zuo S, Zhang H, Gao S, Chen L. Using three-dimensional model-based tumour volume change to predict the symptom improvement in patients with renal cell cancer. 3 Biotech 2024; 14:148. [PMID: 38711822 PMCID: PMC11070407 DOI: 10.1007/s13205-024-03967-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2023] [Accepted: 02/26/2024] [Indexed: 05/08/2024] Open
Abstract
In our recent study, we explored the efficacy of three-dimensional (3D) measurement of tumor volume in predicting the improvement of quality of life (QoL) in patients suffering from renal cell cancer (RCC), who were treated with axitinib and anti-PD-L1 antibodies. This study encompassed 18 RCC patients, including 10 men and 8 women, with an average age of 56.83 ± 9.94 years. By utilizing 3D Slicer software, we analyzed pre- and post-treatment CT scans to assess changes in tumor volume. Patients' QoL was evaluated through the FKSI-DRS questionnaire. Our findings revealed that 3D models for all patients were successfully created, and there was a moderate agreement between treatment response classifications based on RECIST 1.1 criteria and volumetric analysis (kappa = 0.556, p = 0.001). Notably, nine patients reported a clinically meaningful improvement in QoL following the treatment. Interestingly, the change in tumor volume as indicated by the 3D model showed a higher area under the curve in predicting QoL improvement compared to the change in diameter measured by CT, although this difference was not statistically significant (z = 0.593, p = 0.553). Furthermore, a multivariable analysis identified the change in tumor volume based on the 3D model as an independent predictor of QoL improvement (odds ratio = 1.073, 95% CI 1.002-1.149, p = 0.045).In conclusion, our study suggests that the change in tumor volume measured by a 3D model may be a more effective predictor of symptom improvement in RCC patients than traditional CT-based diameter measurements. This offers a novel approach for assessing treatment response and patient well-being, presenting a significant advancement in the field of RCC treatment.
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Affiliation(s)
- ChengWei Fu
- Medical School of Chinese PLA, No. 28 Fuxing Road, Haidian District Beijing, 100853 China
- Department of Urology, The Third Medical Center, Chinese PLA General Hospital, No. 69 Yongding Road, Haidian District, Beijing, 100039 China
- Department of Urology, The Fifth Medical Center Chinese PLA General Hospital, No. Yard 8, Fengtai East Street, Beijing, 100071 China
| | - JinKai Dong
- Department of Urology, The Third Medical Center, Chinese PLA General Hospital, No. 69 Yongding Road, Haidian District, Beijing, 100039 China
- Department of Urology, The Fifth Medical Center Chinese PLA General Hospital, No. Yard 8, Fengtai East Street, Beijing, 100071 China
| | - JingYun Zhang
- Department of Urology, The Fifth Medical Center Chinese PLA General Hospital, No. Yard 8, Fengtai East Street, Beijing, 100071 China
| | - XueChao Li
- Medical School of Chinese PLA, No. 28 Fuxing Road, Haidian District Beijing, 100853 China
- Department of Urology, The Third Medical Center, Chinese PLA General Hospital, No. 69 Yongding Road, Haidian District, Beijing, 100039 China
- Department of Urology, The Fifth Medical Center Chinese PLA General Hospital, No. Yard 8, Fengtai East Street, Beijing, 100071 China
| | - ShiDong Zuo
- Medical School of Chinese PLA, No. 28 Fuxing Road, Haidian District Beijing, 100853 China
- Department of Urology, The Third Medical Center, Chinese PLA General Hospital, No. 69 Yongding Road, Haidian District, Beijing, 100039 China
- Department of Urology, The Fifth Medical Center Chinese PLA General Hospital, No. Yard 8, Fengtai East Street, Beijing, 100071 China
| | - HongTao Zhang
- Department of Radiology, The Fifth Medical Center, Chinese PLA General Hospital, No. Yard 8, Fengtai East Street, Beijing, 100071 China
| | - Shen Gao
- Department of Radiology, The Fifth Medical Center, Chinese PLA General Hospital, No. Yard 8, Fengtai East Street, Beijing, 100071 China
| | - LiJun Chen
- Department of Urology, The Third Medical Center, Chinese PLA General Hospital, No. 69 Yongding Road, Haidian District, Beijing, 100039 China
- Department of Urology, The Fifth Medical Center Chinese PLA General Hospital, No. Yard 8, Fengtai East Street, Beijing, 100071 China
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Kikuchi T, Hanaoka S, Nakao T, Nomura Y, Mori H, Yoshikawa T. Impact of CT-determined low kidney volume on renal function decline: a propensity score-matched analysis. Insights Imaging 2024; 15:102. [PMID: 38578554 PMCID: PMC10997556 DOI: 10.1186/s13244-024-01671-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2023] [Accepted: 03/08/2024] [Indexed: 04/06/2024] Open
Abstract
OBJECTIVES To investigate the relationship between low kidney volume and subsequent estimated glomerular filtration rate (eGFR) decline in eGFR category G2 (60-89 mL/min/1.73 m2) population. METHODS In this retrospective study, we evaluated 5531 individuals with eGFR category G2 who underwent medical checkups at our institution between November 2006 and October 2017. Exclusion criteria were absent for follow-up visit, missing data, prior renal surgery, current renal disease under treatment, large renal masses, and horseshoe kidney. We developed a 3D U-net-based automated system for renal volumetry on CT images. Participants were grouped by sex-specific kidney volume deviations set at mean minus one standard deviation. After 1:1 propensity score matching, we obtained 397 pairs of individuals in the low kidney volume (LKV) and control groups. The primary endpoint was progression of eGFR categories within 5 years, assessed using Cox regression analysis. RESULTS This study included 3220 individuals (mean age, 60.0 ± 9.7 years; men, n = 2209). The kidney volume was 404.6 ± 67.1 and 376.8 ± 68.0 cm3 in men and women, respectively. The low kidney volume (LKV) cutoff was 337.5 and 308.8 cm3 for men and women, respectively. LKV was a significant risk factor for the endpoint with an adjusted hazard ratio of 1.64 (95% confidence interval: 1.09-2.45; p = 0.02). CONCLUSION Low kidney volume may adversely affect subsequent eGFR maintenance; hence, the use of imaging metrics may help predict eGFR decline. CRITICAL RELEVANCE STATEMENT Low kidney volume is a significant predictor of reduced kidney function over time; thus, kidney volume measurements could aid in early identification of individuals at risk for declining kidney health. KEY POINTS • This study explores how kidney volume affects subsequent kidney function maintenance. • Low kidney volume was associated with estimated glomerular filtration rate decreases. • Low kidney volume is a prognostic indicator of estimated glomerular filtration rate decline.
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Affiliation(s)
- Tomohiro Kikuchi
- Department of Computational Diagnostic Radiology and Preventive Medicine, The University of Tokyo Hospital, 7-3-1 Hongo, Bunkyo-Ku, Tokyo, 113-8655, Japan.
- Department of Radiology, Jichi Medical University School of Medicine, 3311-1 Yakushiji, Shimotsuke, Tochigi, 329-0498, Japan.
| | - Shouhei Hanaoka
- Department of Radiology, University of Tokyo Hospital, 7-3-1 Hongo, Bunkyo-Ku, Tokyo, Japan
| | - Takahiro Nakao
- Department of Computational Diagnostic Radiology and Preventive Medicine, The University of Tokyo Hospital, 7-3-1 Hongo, Bunkyo-Ku, Tokyo, 113-8655, Japan
| | - Yukihiro Nomura
- Department of Computational Diagnostic Radiology and Preventive Medicine, The University of Tokyo Hospital, 7-3-1 Hongo, Bunkyo-Ku, Tokyo, 113-8655, Japan
- Center for Frontier Medical Engineering, Chiba University, 1-33 Yayoicho, Inage-Ku, Chiba, Japan
| | - Harushi Mori
- Department of Radiology, Jichi Medical University School of Medicine, 3311-1 Yakushiji, Shimotsuke, Tochigi, 329-0498, Japan
| | - Takeharu Yoshikawa
- Department of Computational Diagnostic Radiology and Preventive Medicine, The University of Tokyo Hospital, 7-3-1 Hongo, Bunkyo-Ku, Tokyo, 113-8655, Japan
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3
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Wesdorp NJ, Zeeuw JM, Postma SCJ, Roor J, van Waesberghe JHTM, van den Bergh JE, Nota IM, Moos S, Kemna R, Vadakkumpadan F, Ambrozic C, van Dieren S, van Amerongen MJ, Chapelle T, Engelbrecht MRW, Gerhards MF, Grunhagen D, van Gulik TM, Hermans JJ, de Jong KP, Klaase JM, Liem MSL, van Lienden KP, Molenaar IQ, Patijn GA, Rijken AM, Ruers TM, Verhoef C, de Wilt JHW, Marquering HA, Stoker J, Swijnenburg RJ, Punt CJA, Huiskens J, Kazemier G. Deep learning models for automatic tumor segmentation and total tumor volume assessment in patients with colorectal liver metastases. Eur Radiol Exp 2023; 7:75. [PMID: 38038829 PMCID: PMC10692044 DOI: 10.1186/s41747-023-00383-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2023] [Accepted: 09/08/2023] [Indexed: 12/02/2023] Open
Abstract
BACKGROUND We developed models for tumor segmentation to automate the assessment of total tumor volume (TTV) in patients with colorectal liver metastases (CRLM). METHODS In this prospective cohort study, pre- and post-systemic treatment computed tomography (CT) scans of 259 patients with initially unresectable CRLM of the CAIRO5 trial (NCT02162563) were included. In total, 595 CT scans comprising 8,959 CRLM were divided into training (73%), validation (6.5%), and test sets (21%). Deep learning models were trained with ground truth segmentations of the liver and CRLM. TTV was calculated based on the CRLM segmentations. An external validation cohort was included, comprising 72 preoperative CT scans of patients with 112 resectable CRLM. Image segmentation evaluation metrics and intraclass correlation coefficient (ICC) were calculated. RESULTS In the test set (122 CT scans), the autosegmentation models showed a global Dice similarity coefficient (DSC) of 0.96 (liver) and 0.86 (CRLM). The corresponding median per-case DSC was 0.96 (interquartile range [IQR] 0.95-0.96) and 0.80 (IQR 0.67-0.87). For tumor segmentation, the intersection-over-union, precision, and recall were 0.75, 0.89, and 0.84, respectively. An excellent agreement was observed between the reference and automatically computed TTV for the test set (ICC 0.98) and external validation cohort (ICC 0.98). In the external validation, the global DSC was 0.82 and the median per-case DSC was 0.60 (IQR 0.29-0.76) for tumor segmentation. CONCLUSIONS Deep learning autosegmentation models were able to segment the liver and CRLM automatically and accurately in patients with initially unresectable CRLM, enabling automatic TTV assessment in such patients. RELEVANCE STATEMENT Automatic segmentation enables the assessment of total tumor volume in patients with colorectal liver metastases, with a high potential of decreasing radiologist's workload and increasing accuracy and consistency. KEY POINTS • Tumor response evaluation is time-consuming, manually performed, and ignores total tumor volume. • Automatic models can accurately segment tumors in patients with colorectal liver metastases. • Total tumor volume can be accurately calculated based on automatic segmentations.
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Affiliation(s)
- Nina J Wesdorp
- Department of Surgery, Cancer Center Amsterdam, Amsterdam UMC, Vrije Universiteit Amsterdam, De Boelelaan 1117, 1081 HV, Amsterdam, the Netherlands.
| | - J Michiel Zeeuw
- Department of Surgery, Cancer Center Amsterdam, Amsterdam UMC, Vrije Universiteit Amsterdam, De Boelelaan 1117, 1081 HV, Amsterdam, the Netherlands.
| | - Sam C J Postma
- Department of Surgery, Cancer Center Amsterdam, Amsterdam UMC, Vrije Universiteit Amsterdam, De Boelelaan 1117, 1081 HV, Amsterdam, the Netherlands
| | - Joran Roor
- Department of Health, SAS Institute B.V, Huizen, the Netherlands
| | - Jan Hein T M van Waesberghe
- Department of Radiology and Nuclear Medicine, Cancer Center Amsterdam, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Janneke E van den Bergh
- Department of Radiology and Nuclear Medicine, Cancer Center Amsterdam, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Irene M Nota
- Department of Radiology and Nuclear Medicine, Cancer Center Amsterdam, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Shira Moos
- Department of Radiology and Nuclear Medicine, Cancer Center Amsterdam, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Ruby Kemna
- Department of Surgery, Cancer Center Amsterdam, Amsterdam UMC, Vrije Universiteit Amsterdam, De Boelelaan 1117, 1081 HV, Amsterdam, the Netherlands
| | - Fijoy Vadakkumpadan
- Department of Computer Vision and Machine Learning, SAS Institute Inc, Cary, NC, USA
| | - Courtney Ambrozic
- Department of Computer Vision and Machine Learning, SAS Institute Inc, Cary, NC, USA
| | - Susan van Dieren
- Department of Surgery, Cancer Center Amsterdam, Amsterdam UMC, Vrije Universiteit Amsterdam, De Boelelaan 1117, 1081 HV, Amsterdam, the Netherlands
| | | | - Thiery Chapelle
- Department of Hepatobiliary, Transplantation, and Endocrine Surgery, Antwerp University Hospital, Antwerp, Belgium
| | - Marc R W Engelbrecht
- Department of Radiology and Nuclear Medicine, Cancer Center Amsterdam, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | | | - Dirk Grunhagen
- Department of Surgical Oncology and Gastrointestinal Surgery, Erasmus MC Cancer Institute, Rotterdam, the Netherlands
| | - Thomas M van Gulik
- Department of Surgery, Cancer Center Amsterdam, Amsterdam UMC, Vrije Universiteit Amsterdam, De Boelelaan 1117, 1081 HV, Amsterdam, the Netherlands
| | - John J Hermans
- Department of Medical Imaging, Radboud University Medical Center, Radboud University Nijmegen, Nijmegen, the Netherlands
| | - Koert P de Jong
- Department of HPB Surgery and Liver Transplantation, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Joost M Klaase
- Department of HPB Surgery and Liver Transplantation, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Mike S L Liem
- Department of Surgery, Medical Spectrum Twente, Enschede, the Netherlands
| | - Krijn P van Lienden
- Department of Interventional Radiology, St Antonius Hospital, Nieuwegein, the Netherlands
| | - I Quintus Molenaar
- Department of Surgery, Regional Academic Cancer Center Utrecht, University Medical Center Utrecht, Utrecht, the Netherlands
- Department of Surgery, St Antonius Hospital, Nieuwegein, the Netherlands
| | - Gijs A Patijn
- Department of Surgery, Isala Hospital, Zwolle, the Netherlands
| | - Arjen M Rijken
- Department of Surgery, Amphia Hospital, Breda, the Netherlands
| | - Theo M Ruers
- Department of Surgery, Cancer Center Amsterdam, Amsterdam UMC, Vrije Universiteit Amsterdam, De Boelelaan 1117, 1081 HV, Amsterdam, the Netherlands
| | - Cornelis Verhoef
- Department of Surgical Oncology and Gastrointestinal Surgery, Erasmus MC Cancer Institute, Rotterdam, the Netherlands
| | - Johannes H W de Wilt
- Department of Surgery, Radboud University Medical Center, Radboud University Nijmegen, Nijmegen, the Netherlands
| | - Henk A Marquering
- Department of Radiology and Nuclear Medicine, Cancer Center Amsterdam, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
- Department of Biomedical Engineering and Physics, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| | - Jaap Stoker
- Department of Radiology and Nuclear Medicine, Cancer Center Amsterdam, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Rutger-Jan Swijnenburg
- Department of Surgery, Cancer Center Amsterdam, Amsterdam UMC, Vrije Universiteit Amsterdam, De Boelelaan 1117, 1081 HV, Amsterdam, the Netherlands
| | - Cornelis J A Punt
- Department of Medical Oncology, Cancer Center Amsterdam, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
- Department of Epidemiology, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Joost Huiskens
- Department of Surgery, Cancer Center Amsterdam, Amsterdam UMC, Vrije Universiteit Amsterdam, De Boelelaan 1117, 1081 HV, Amsterdam, the Netherlands
| | - Geert Kazemier
- Department of Surgery, Cancer Center Amsterdam, Amsterdam UMC, Vrije Universiteit Amsterdam, De Boelelaan 1117, 1081 HV, Amsterdam, the Netherlands
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Yang S, Zhang Z, Su T, Chen Q, Wang H, Jin L. Comparison of quantitative volumetric analysis and linear measurement for predicting the survival of Barcelona Clinic Liver Cancer 0- and A stage hepatocellular carcinoma after radiofrequency ablation. Diagn Interv Radiol 2023; 29:450-459. [PMID: 37154818 PMCID: PMC10679614 DOI: 10.4274/dir.2023.222055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2022] [Accepted: 04/13/2023] [Indexed: 05/10/2023]
Abstract
PURPOSE The prognostic role of the tumor volume in patients with hepatocellular carcinoma (HCC) at the Barcelona Clinic Liver Cancer (BCLC) 0 and A stages remains unclear. This study aims to compare the volumetric measurement with linear measurement in early HCC burden profile and clarify the optimal cut-off value of the tumor volume. METHODS The consecutive patients diagnosed with HCC who underwent initial and curative-intent radiofrequency ablation (RFA) were included retrospectively. The segmentation was performed semi-automatically, and enhanced tumor volume (ETV) as well as total tumor volume (TTV) were obtained. The patients were categorized into high- and low-tumor burden groups according to various cutoff values derived from commonly used diameter values, X-tile software, and decision-tree analysis. The inter- and intra-reviewer agreements were measured using the intra-class correlation coefficient. Univariate and multivariate time-to-event Cox regression analyses were performed to identify the prognostic factors of overall survival. RESULTS A total of 73 patients with 81 lesions were analyzed in the whole cohort with a median follow-up of 31.0 (interquartile range: 16.0–36.3). In tumor segmentation, excellent consistency was observed in intra- and inter-reviewer assessments. There was a strong correlation between diameter-derived spherical volume and ETV as well as ETV and TTV. As opposed to all linear candidates and 4,188 mm3 (sphere equivalent to 2 cm in diameter), ETV >14,137 mm3 (sphere equivalent to 3 cm in diameter) or 23,000 mm3 (sphere equivalent to 3.5 cm in diameter) was identified as an independent risk factor of survival. Considering the value of hazard ratio and convenience to use, when ETV was at 23,000 mm3, it was regarded as the optimal volumetric cut-off value in differentiating survival risk. CONCLUSION The volumetric measurement outperforms linear measurement on tumor burden evaluation for survival stratification in patients at BCLC 0 and A stages HCC after RFA.
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Affiliation(s)
- Siwei Yang
- Department of Interventional Radiology, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Zhiyuan Zhang
- Department of Interventional Radiology, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Tianhao Su
- Department of Interventional Radiology, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Qiyang Chen
- Department of Ultrasound, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Haochen Wang
- Department of Interventional Radiology, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Long Jin
- Department of Interventional Radiology, Beijing Friendship Hospital, Capital Medical University, Beijing, China
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Staal FC, Taghavi M, Hong EK, Tissier R, van Treijen M, Heeres BC, van der Zee D, Tesselaar ME, Beets-Tan RG, Maas M. CT-based radiomics to distinguish progressive from stable neuroendocrine liver metastases treated with somatostatin analogues: an explorative study. Acta Radiol 2023; 64:1062-1070. [PMID: 35702011 DOI: 10.1177/02841851221106598] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Accurate response evaluation in patients with neuroendocrine liver metastases (NELM) remains a challenge. Radiomics has shown promising results regarding response assessment. PURPOSE To differentiate progressive (PD) from stable disease (SD) with radiomics in patients with NELM undergoing somatostatin analogue (SSA) treatment. MATERIAL AND METHODS A total of 46 patients with histologically confirmed gastroenteropancreatic neuroendocrine tumors (GEP-NET) with ≥1 NELM and ≥2 computed tomography (CT) scans were included. Response was assessed with Response Evaluation Criteria in Solid Tumors (RECIST1.1). Hepatic target lesions were manually delineated and analyzed with radiomics. Radiomics features were extracted from each NELM on both arterial-phase (AP) and portal-venous-phase (PVP) CT. Multiple instance learning with regularized logistic regression via LASSO penalization (with threefold cross-validation) was used to classify response. Three models were computed: (i) AP model; (ii) PVP model; and (iii) AP + PVP model for a lesion-based and patient-based outcome. Next, clinical features were added to each model. RESULTS In total, 19 (40%) patients had PD. Median follow-up was 13 months (range 1-50 months). Radiomics models could not accurately classify response (area under the curve 0.44-0.60). Adding clinical variables to the radiomics models did not significantly improve the performance of any model. CONCLUSION Radiomics features were not able to accurately classify response of NELM on surveillance CT scans during SSA treatment.
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Affiliation(s)
- Femke Cr Staal
- Department of Radiology, 1228The Netherlands Cancer Institute, Amsterdam, The Netherlands
- GROW School for Oncology and Developmental Biology, 5211Maastricht University Medical Centre, Maastricht, The Netherlands
- Center for Neuroendocrine Tumors, ENETS Center of Excellence, 1228Netherlands Cancer Institute Amsterdam/University Medical Center Utrecht, Utrecht, The Netherlands
| | - M Taghavi
- Department of Radiology, 1228The Netherlands Cancer Institute, Amsterdam, The Netherlands
- GROW School for Oncology and Developmental Biology, 5211Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Eun K Hong
- Department of Radiology, 1228The Netherlands Cancer Institute, Amsterdam, The Netherlands
- GROW School for Oncology and Developmental Biology, 5211Maastricht University Medical Centre, Maastricht, The Netherlands
- Department of Radiology, 26725Seoul National University Hospital, Seoul, Republic of Korea
| | - Renaud Tissier
- Biostatistics Center, 1228The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Mark van Treijen
- Center for Neuroendocrine Tumors, ENETS Center of Excellence, 1228Netherlands Cancer Institute Amsterdam/University Medical Center Utrecht, Utrecht, The Netherlands
- Department of Endocrine Oncology, 8124University Medical Centre Utrecht, Utrecht, The Netherlands
| | - Birthe C Heeres
- Department of Radiology, 1228The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | | | - Margot Et Tesselaar
- Center for Neuroendocrine Tumors, ENETS Center of Excellence, 1228Netherlands Cancer Institute Amsterdam/University Medical Center Utrecht, Utrecht, The Netherlands
- Department of Medical Oncology, 1228The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Regina Gh Beets-Tan
- Department of Radiology, 1228The Netherlands Cancer Institute, Amsterdam, The Netherlands
- GROW School for Oncology and Developmental Biology, 5211Maastricht University Medical Centre, Maastricht, The Netherlands
- Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark
| | - Monique Maas
- Department of Radiology, 1228The Netherlands Cancer Institute, Amsterdam, The Netherlands
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Hofmann FO, Heinemann V, D’Anastasi M, Gesenhues AB, Hesse N, von Weikersthal LF, Decker T, Kiani A, Moehler M, Kaiser F, Heintges T, Kahl C, Kullmann F, Scheithauer W, Link H, Modest DP, Stintzing S, Holch JW. Standard diametric versus volumetric early tumor shrinkage as a predictor of survival in metastatic colorectal cancer: subgroup findings of the randomized, open-label phase III trial FIRE-3 / AIO KRK-0306. Eur Radiol 2023; 33:1174-1184. [PMID: 35976398 PMCID: PMC9889429 DOI: 10.1007/s00330-022-09053-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Revised: 05/16/2022] [Accepted: 07/24/2022] [Indexed: 02/07/2023]
Abstract
OBJECTIVES Early tumor shrinkage (ETS) quantifies the objective response at the first assessment during systemic treatment. In metastatic colorectal cancer (mCRC), ETS gains relevance as an early available surrogate for patient survival. The aim of this study was to increase the predictive accuracy of ETS by using semi-automated volumetry instead of standard diametric measurements. METHODS Diametric and volumetric ETS were retrospectively calculated in 253 mCRC patients who received 5-fluorouracil, leucovorin, and irinotecan (FOLFIRI) combined with either cetuximab or bevacizumab. The association of diametric and volumetric ETS with overall survival (OS) and progression-free survival (PFS) was compared. RESULTS Continuous diametric and volumetric ETS predicted survival similarly regarding concordance indices (p > .05). In receiver operating characteristics, a volumetric threshold of 45% optimally identified short-term survivors. For patients with volumetric ETS ≥ 45% (vs < 45%), median OS was longer (32.5 vs 19.0 months, p < .001) and the risk of death reduced for the first and second year (hazard ratio [HR] = 0.25, p < .001, and HR = 0.39, p < .001). Patients with ETS ≥ 45% had a reduced risk of progressive disease only for the first 6 months (HR = 0.26, p < .001). These survival times and risks were comparable to those of diametric ETS ≥ 20% (vs < 20%). CONCLUSIONS The accuracy of ETS in predicting survival was not increased by volumetric instead of diametric measurements. Continuous diametric and volumetric ETS similarly predicted survival, regardless of whether patients received cetuximab or bevacizumab. A volumetric ETS threshold of 45% and a diametric ETS threshold of 20% equally identified short-term survivors. KEY POINTS • ETS based on volumetric measurements did not predict survival more accurately than ETS based on standard diametric measurements. • Continuous diametric and volumetric ETS predicted survival similarly in patients receiving FOLFIRI with cetuximab or bevacizumab. • A volumetric ETS threshold of 45% and a diametric ETS threshold of 20% equally identified short-term survivors.
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Affiliation(s)
- Felix O. Hofmann
- Department of Radiology, University Hospital, LMU Munich, Marchioninistrasse 15, 81377 Munich, Germany ,Department of General, Visceral and Transplantation Surgery, University Hospital, LMU Munich, Marchioninistrasse 15, 81377 Munich, Germany ,German Cancer Consortium (DKTK), partner site Munich, and German Cancer Research Centre (DKFZ), Heidelberg, Germany
| | - Volker Heinemann
- German Cancer Consortium (DKTK), partner site Munich, and German Cancer Research Centre (DKFZ), Heidelberg, Germany ,Department of Medicine III, Comprehensive Cancer Center Munich, University Hospital Grosshadern, LMU Munich, Marchioninistrasse 15, 81377 Munich, Germany
| | - Melvin D’Anastasi
- Department of Radiology, University Hospital, LMU Munich, Marchioninistrasse 15, 81377 Munich, Germany ,Mater Dei Hospital, University of Malta, Triq tal-Qroqq, Msida, MSD2090 Malta
| | - Alena B. Gesenhues
- Department of Radiology, University Hospital, LMU Munich, Marchioninistrasse 15, 81377 Munich, Germany
| | - Nina Hesse
- Department of Radiology, University Hospital, LMU Munich, Marchioninistrasse 15, 81377 Munich, Germany
| | | | | | - Alexander Kiani
- Department of Medicine IV, Klinikum Bayreuth GmbH, Bayreuth, Germany ,Comprehensive Cancer Center Erlangen-EMN (CCC ER-EMN), Erlangen, Germany
| | - Markus Moehler
- Department of Internal Medicine I, University Medical Center Mainz, Mainz, Germany
| | | | | | - Christoph Kahl
- Department of Hematology, Oncology and Palliative Care, Klinikum Magdeburg gGmbH, Magdeburg, Germany
| | - Frank Kullmann
- Department of Internal Medicine I, Hospital Weiden, Weiden, Germany
| | - Werner Scheithauer
- Department of Internal Medicine I and Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
| | - Hartmut Link
- Department of Medicine I, Westpfalz-Klinikum GmbH, Kaiserslautern, Germany
| | - Dominik P. Modest
- Medical Department of Hematology, Oncology and Cancer Immunology (CCM), Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Sebastian Stintzing
- Medical Department of Hematology, Oncology and Cancer Immunology (CCM), Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Julian W. Holch
- German Cancer Consortium (DKTK), partner site Munich, and German Cancer Research Centre (DKFZ), Heidelberg, Germany ,Department of Medicine III, Comprehensive Cancer Center Munich, University Hospital Grosshadern, LMU Munich, Marchioninistrasse 15, 81377 Munich, Germany
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7
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Peterfy C, Chen Y, Countryman P, Chmielowski B, Anthony SP, Healey JH, Wainberg ZA, Cohn AL, Shapiro GI, Keedy VL, Singh A, Puzanov I, Wagner AJ, Qian M, Sterba M, Hsu HH, Tong-Starksen S, Tap WD. CSF1 receptor inhibition of tenosynovial giant cell tumor using novel disease-specific MRI measures of tumor burden. Future Oncol 2022; 18:1449-1459. [PMID: 35040698 PMCID: PMC11197039 DOI: 10.2217/fon-2021-1437] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2021] [Accepted: 01/05/2022] [Indexed: 11/21/2022] Open
Abstract
Aim: Monitoring treatment of tenosynovial giant cell tumor (TGCT) is complicated by the irregular shape and asymmetrical growth of the tumor. We compared responses to pexidartinib by Response Evaluation Criteria in Solid Tumors (RECIST) 1.1 with those by tumor volume score (TVS) and modified RECIST (m-RECIST). Materials & methods: MRIs acquired every two cycles were assessed centrally using RECIST 1.1, m-RECIST and TVS and tissue damage score (TDS). Results: Thirty-one evaluable TGCT patients were treated with pexidartinib. From baseline to last visit, 94% of patients (29/31) showed a decrease in tumor size (median change: -60% [RECIST], -66% [m-RECIST], -79% [TVS]). All methods showed 100% disease control rate. For TDS, improvements were seen in bone erosion (32%), bone marrow edema (58%) and knee effusion (46%). Conclusion: TVS and m-RECIST offer potentially superior alternatives to conventional RECIST for monitoring disease progression and treatment response in TGCT. TDS adds important information about joint damage associated with TGCT.
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Affiliation(s)
| | - Yan Chen
- Spire Sciences, Inc., Boca Raton,
FL, USA
| | | | - Bartosz Chmielowski
- University of California Los Angeles, Jonsson Comprehensive Cancer Center,
Los Angeles, CA90095, USA
| | | | - John H Healey
- Memorial Sloan Kettering Cancer Center & Weill Cornell Medical College,
New York, NY10065, USA
| | | | - Allen L Cohn
- Rocky Mountain Cancer Centers,
Denver, CO80216, USA
| | - Geoffrey I Shapiro
- Dana–Farber Cancer Institute & Harvard Medical School,
Boston, MA02215, USA
| | - Vicki L Keedy
- Vanderbilt University Medical Center,
Nashville, TN37235, USA
| | - Arun Singh
- UCLA Medical Center,
Santa Monica, CA90404, USA
| | - Igor Puzanov
- Roswell Park Comprehensive Cancer Center,
Buffalo, NY14203, USA
| | - Andrew J Wagner
- Dana–Farber Cancer Institute & Harvard Medical School,
Boston, MA02215, USA
| | - Meng Qian
- Daiichi Sankyo, Inc.,
Basking Ridge, NJ07920, USA
| | - Mike Sterba
- Plexxikon Inc.,
South San Francisco,
CA94080, USA
| | - Henry H Hsu
- Plexxikon Inc.,
South San Francisco,
CA94080, USA
| | | | - William D Tap
- Memorial Sloan Kettering Cancer Center & Weill Cornell Medical College,
New York, NY10065, USA
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8
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Fournier L, de Geus-Oei LF, Regge D, Oprea-Lager DE, D’Anastasi M, Bidaut L, Bäuerle T, Lopci E, Cappello G, Lecouvet F, Mayerhoefer M, Kunz WG, Verhoeff JJC, Caruso D, Smits M, Hoffmann RT, Gourtsoyianni S, Beets-Tan R, Neri E, deSouza NM, Deroose CM, Caramella C. Twenty Years On: RECIST as a Biomarker of Response in Solid Tumours an EORTC Imaging Group - ESOI Joint Paper. Front Oncol 2022; 11:800547. [PMID: 35083155 PMCID: PMC8784734 DOI: 10.3389/fonc.2021.800547] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2021] [Accepted: 11/30/2021] [Indexed: 12/15/2022] Open
Abstract
Response evaluation criteria in solid tumours (RECIST) v1.1 are currently the reference standard for evaluating efficacy of therapies in patients with solid tumours who are included in clinical trials, and they are widely used and accepted by regulatory agencies. This expert statement discusses the principles underlying RECIST, as well as their reproducibility and limitations. While the RECIST framework may not be perfect, the scientific bases for the anticancer drugs that have been approved using a RECIST-based surrogate endpoint remain valid. Importantly, changes in measurement have to meet thresholds defined by RECIST for response classification within thus partly circumventing the problems of measurement variability. The RECIST framework also applies to clinical patients in individual settings even though the relationship between tumour size changes and outcome from cohort studies is not necessarily translatable to individual cases. As reproducibility of RECIST measurements is impacted by reader experience, choice of target lesions and detection/interpretation of new lesions, it can result in patients changing response categories when measurements are near threshold values or if new lesions are missed or incorrectly interpreted. There are several situations where RECIST will fail to evaluate treatment-induced changes correctly; knowledge and understanding of these is crucial for correct interpretation. Also, some patterns of response/progression cannot be correctly documented by RECIST, particularly in relation to organ-site (e.g. bone without associated soft-tissue lesion) and treatment type (e.g. focal therapies). These require specialist reader experience and communication with oncologists to determine the actual impact of the therapy and best evaluation strategy. In such situations, alternative imaging markers for tumour response may be used but the sources of variability of individual imaging techniques need to be known and accounted for. Communication between imaging experts and oncologists regarding the level of confidence in a biomarker is essential for the correct interpretation of a biomarker and its application to clinical decision-making. Though measurement automation is desirable and potentially reduces the variability of results, associated technical difficulties must be overcome, and human adjudications may be required.
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Affiliation(s)
- Laure Fournier
- Imaging Group, European Organisation of Research and Treatment in Cancer (EORTC), Brussels, Belgium
- European Society of Oncologic Imaging (ESOI), European Society of Radiology, Vienna, Austria
- Université de Paris, Assistance Publique–Hôpitaux de Paris (AP-HP), Hopital europeen Georges Pompidou, Department of Radiology, Paris Cardiovascular Research Center (PARCC) Unité Mixte de Recherche (UMRS) 970, Institut national de la santé et de la recherche médicale (INSERM), Paris, France
| | - Lioe-Fee de Geus-Oei
- Imaging Group, European Organisation of Research and Treatment in Cancer (EORTC), Brussels, Belgium
- Department of Radiology, Leiden University Medical Center, Leiden, Netherlands
- Biomedical Photonic Imaging Group, University of Twente, Enschede, Netherlands
| | - Daniele Regge
- European Society of Oncologic Imaging (ESOI), European Society of Radiology, Vienna, Austria
- Department of Surgical Sciences, University of Turin, Turin, Italy
- Radiology Unit, Candiolo Cancer Institute, Fondazione del Piemonte per l’Oncologia-Istituto Di Ricovero e Cura a Carattere Scientifico (FPO-IRCCS), Turin, Italy
| | - Daniela-Elena Oprea-Lager
- Imaging Group, European Organisation of Research and Treatment in Cancer (EORTC), Brussels, Belgium
- Department of Radiology & Nuclear Medicine, Cancer Centre Amsterdam, Amsterdam University Medical Centers [Vrije Universiteit (VU) University], Amsterdam, Netherlands
| | - Melvin D’Anastasi
- European Society of Oncologic Imaging (ESOI), European Society of Radiology, Vienna, Austria
- Medical Imaging Department, Mater Dei Hospital, University of Malta, Msida, Malta
| | - Luc Bidaut
- Imaging Group, European Organisation of Research and Treatment in Cancer (EORTC), Brussels, Belgium
- College of Science, University of Lincoln, Lincoln, United Kingdom
| | - Tobias Bäuerle
- European Society of Oncologic Imaging (ESOI), European Society of Radiology, Vienna, Austria
- Institute of Radiology, University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Erlangen, Germany
| | - Egesta Lopci
- Imaging Group, European Organisation of Research and Treatment in Cancer (EORTC), Brussels, Belgium
- Nuclear Medicine Unit, Istituto Di Ricovero e Cura a Carattere Scientifico (IRCCS) – Humanitas Research Hospital, Milan, Italy
| | - Giovanni Cappello
- Department of Surgical Sciences, University of Turin, Turin, Italy
- Radiology Unit, Candiolo Cancer Institute, Fondazione del Piemonte per l’Oncologia-Istituto Di Ricovero e Cura a Carattere Scientifico (FPO-IRCCS), Turin, Italy
| | - Frederic Lecouvet
- Imaging Group, European Organisation of Research and Treatment in Cancer (EORTC), Brussels, Belgium
- Department of Radiology, Institut de Recherche Expérimentale et Clinique (IREC), Cliniques Universitaires Saint Luc, Université Catholique de Louvain (UCLouvain), Brussels, Belgium
| | - Marius Mayerhoefer
- European Society of Oncologic Imaging (ESOI), European Society of Radiology, Vienna, Austria
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY, United States
- Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Vienna, Austria
| | - Wolfgang G. Kunz
- Imaging Group, European Organisation of Research and Treatment in Cancer (EORTC), Brussels, Belgium
- European Society of Oncologic Imaging (ESOI), European Society of Radiology, Vienna, Austria
- Department of Radiology, University Hospital, Ludwig Maximilian University (LMU) Munich, Munich, Germany
| | - Joost J. C. Verhoeff
- Imaging Group, European Organisation of Research and Treatment in Cancer (EORTC), Brussels, Belgium
- Department of Radiotherapy, University Medical Center Utrecht, Utrecht University, Utrecht, Netherlands
| | - Damiano Caruso
- European Society of Oncologic Imaging (ESOI), European Society of Radiology, Vienna, Austria
- Department of Medical-Surgical Sciences and Translational Medicine, Sapienza University of Rome, Rome, Italy
| | - Marion Smits
- Imaging Group, European Organisation of Research and Treatment in Cancer (EORTC), Brussels, Belgium
- Department of Radiology & Nuclear Medicine, Erasmus MC, University Medical Centre Rotterdam, Rotterdam, Netherlands
- Brain Tumour Centre, Erasmus Medical Centre (MC) Cancer Institute, Rotterdam, Netherlands
| | - Ralf-Thorsten Hoffmann
- European Society of Oncologic Imaging (ESOI), European Society of Radiology, Vienna, Austria
- Institute and Policlinic for Diagnostic and Interventional Radiology, University Hospital, Carl-Gustav-Carus Technical University Dresden, Dresden, Germany
| | - Sofia Gourtsoyianni
- European Society of Oncologic Imaging (ESOI), European Society of Radiology, Vienna, Austria
- Department of Radiology, School of Medicine, National and Kapodistrian University of Athens, Areteion Hospital, Athens, Greece
| | - Regina Beets-Tan
- European Society of Oncologic Imaging (ESOI), European Society of Radiology, Vienna, Austria
- Department of Radiology, The Netherlands Cancer Institute, Amsterdam, Netherlands
- School For Oncology and Developmental Biology (GROW) School for Oncology and Developmental Biology, Maastricht University, Maastricht, Netherlands
| | - Emanuele Neri
- European Society of Oncologic Imaging (ESOI), European Society of Radiology, Vienna, Austria
- Diagnostic and Interventional Radiology, Department of Translational Research and of New Surgical and Medical Technologies, University of Pisa, Pisa, Italy
| | - Nandita M. deSouza
- Imaging Group, European Organisation of Research and Treatment in Cancer (EORTC), Brussels, Belgium
- Division of Radiotherapy and Imaging, The Institute of Cancer Research and Royal Marsden National Health Service (NHS) Foundation Trust, London, United Kingdom
- European Imaging Biomarkers Alliance (EIBALL), European Society of Radiology, Vienna, Austria
- Quantitative Imaging Biomarkers Alliance, Radiological Society of North America, Oak Brook, IL, United States
| | - Christophe M. Deroose
- Imaging Group, European Organisation of Research and Treatment in Cancer (EORTC), Brussels, Belgium
- Nuclear Medicine, University Hospitals Leuven, Leuven, Belgium
- Nuclear Medicine & Molecular Imaging, Department of Imaging and Pathology, Katholieke Universiteit (KU) Leuven, Leuven, Belgium
| | - Caroline Caramella
- Imaging Group, European Organisation of Research and Treatment in Cancer (EORTC), Brussels, Belgium
- Radiology Department, Hôpital Marie Lannelongue, Groupe Hospitalier Paris Saint Joseph Centre International des Cancers Thoraciques, Université Paris-Saclay, Le Plessis-Robinson, France
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9
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García-Figueiras R, Baleato-González S, Canedo-Antelo M, Alcalá L, Marhuenda A. Imaging Advances on CT and MRI in Colorectal Cancer. CURRENT COLORECTAL CANCER REPORTS 2021. [DOI: 10.1007/s11888-021-00468-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
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10
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Volumetric measurements of target lesions: does it improve inter-reader variability for oncological response assessment according to RECIST 1.1 guidelines compared to standard unidimensional measurements? Pol J Radiol 2021; 86:e594-e600. [PMID: 34876940 PMCID: PMC8634421 DOI: 10.5114/pjr.2021.111048] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2020] [Accepted: 11/23/2020] [Indexed: 11/30/2022] Open
Abstract
Purpose Target lesion selection is known to be a major factor for inter-reader discordance in RECIST 1.1. The purpose of this study was to assess whether volumetric measurements of target lesions result in different response categorization, as opposed to standard unidimensional measurements, and to evaluate the impact on inter-reader agreement for response categorization when different readers select different sets of target lesions. Material and methods Fifty patients with measurable disease from solid tumours, in which 3 readers had blindly and independently selected different sets of target lesions and subsequently reached clinically significant discordant response categorizations (progressive disease [PD] vs. non-progressive disease [non-PD]) based on RECIST 1.1 analyses were included in this study. Additional volumetric measurements of all target lesions were performed by the same readers in a second read. Intra-reader agreement between standard unidimensional measurements (uRECIST) and volumetric measurements (vRECIST) was assessed using Cohen’s k statistics. Fleiss k statistics was used to analyse the inter-reader agreement for uRECIST and vRECIST results. Results The 3 readers assigned the same response classifications based on uRECIST and vRECIST in 33/50 (66%), 42/50 patients (84%), and 44/50 patients (88%), respectively. Inter-reader agreement improved from 0% when using uRECIST to 36% when using vRECIST. Conclusions Volumetric measurement of target lesions may improve inter-reader variability for response assessment as opposed to standard unidimensional measurements. However, in about two-thirds of patients, readers disagreed regardless of the measurement method, indicating that a limited set of target lesions may not be sufficiently representative of the whole-body tumour burden.
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11
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Wesdorp NJ, Bolhuis K, Roor J, van Waesberghe JHTM, van Dieren S, van Amerongen MJ, Chapelle T, Dejong CHC, Engelbrecht MRW, Gerhards MF, Grunhagen D, van Gulik TM, Hermans JJ, de Jong KP, Klaase JM, Liem MSL, van Lienden KP, Molenaar IQ, Patijn GA, Rijken AM, Ruers TM, Verhoef C, de Wilt JHW, Swijnenburg RJ, Punt CJA, Huiskens J, Kazemier G. The Prognostic Value of Total Tumor Volume Response Compared With RECIST1.1 in Patients With Initially Unresectable Colorectal Liver Metastases Undergoing Systemic Treatment. ANNALS OF SURGERY OPEN 2021; 2:e103. [PMID: 37637880 PMCID: PMC10455281 DOI: 10.1097/as9.0000000000000103] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2021] [Accepted: 09/17/2021] [Indexed: 01/20/2023] Open
Abstract
Objectives Compare total tumor volume (TTV) response after systemic treatment to Response Evaluation Criteria in Solid Tumors (RECIST1.1) and assess the prognostic value of TTV change and RECIST1.1 for recurrence-free survival (RFS) in patients with colorectal liver-only metastases (CRLM). Background RECIST1.1 provides unidimensional criteria to evaluate tumor response to systemic therapy. Those criteria are accepted worldwide but are limited by interobserver variability and ignore potentially valuable information about TTV. Methods Patients with initially unresectable CRLM receiving systemic treatment from the randomized, controlled CAIRO5 trial (NCT02162563) were included. TTV response was assessed using software specifically developed together with SAS analytics. Baseline and follow-up computed tomography (CT) scans were used to calculate RECIST1.1 and TTV response to systemic therapy. Different thresholds (10%, 20%, 40%) were used to define response of TTV as no standard currently exists. RFS was assessed in a subgroup of patients with secondarily resectable CRLM after induction treatment. Results A total of 420 CT scans comprising 7820 CRLM in 210 patients were evaluated. In 30% to 50% (depending on chosen TTV threshold) of patients, discordance was observed between RECIST1.1 and TTV change. A TTV decrease of >40% was observed in 47 (22%) patients who had stable disease according to RECIST1.1. In 118 patients with secondarily resectable CRLM, RFS was shorter for patients with less than 10% TTV decrease compared with patients with more than 10% TTV decrease (P = 0.015), while RECIST1.1 was not prognostic (P = 0.821). Conclusions TTV response assessment shows prognostic potential in the evaluation of systemic therapy response in patients with CRLM.
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Affiliation(s)
- Nina J. Wesdorp
- From the Department of Surgery, Cancer Center Amsterdam, Amsterdam University Medical Centers, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Karen Bolhuis
- Department of Medical Oncology, Cancer Center Amsterdam, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, The Netherlands
| | - Joran Roor
- Department of Health, SAS Institute B.V., Huizen, The Netherlands
| | - Jan-Hein T. M. van Waesberghe
- Department of Radiology and Molecular Imaging, Cancer Center Amsterdam, Amsterdam University Medical Centers, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Susan van Dieren
- Department of Surgery, Cancer Center Amsterdam, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, The Netherlands
| | - Martin J. van Amerongen
- Department of Medical Imaging, Radboud University Medical Center, Radboud University Nijmegen, Nijmegen, The Netherlands
| | - Thiery Chapelle
- Department of Hepatobiliary, Transplantation, and Endocrine Surgery, Antwerp University Hospital, Antwerp, Belgium
| | - Cornelis H. C. Dejong
- Department of Surgery, Maastricht University Medical Center, Maastricht, The Netherlands
- Department of Surgery, Universitätsklinikum Aachen, Aachen, Germany
| | - Marc R. W. Engelbrecht
- Department of Radiology, Cancer Center Amsterdam, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, The Netherlands
| | - Michael F. Gerhards
- Department of Surgery, Onze Lieve Vrouwe Gasthuis Hospital, Amsterdam, The Netherlands
| | - Dirk Grunhagen
- Department of Surgical Oncology and Gastrointestinal Surgery, Erasmus University Medical Center Cancer Institute, Rotterdam, The Netherlands
| | - Thomas M. van Gulik
- Department of Surgery, Cancer Center Amsterdam, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, The Netherlands
| | - John J. Hermans
- Department of Medical Imaging, Radboud University Medical Center, Radboud University Nijmegen, Nijmegen, The Netherlands
| | - Koert P. de Jong
- Department of Surgery, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Joost M. Klaase
- Department of Surgery, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Mike S. L. Liem
- Department of Surgery, Medical Spectrum Twente, Enschede, The Netherlands
| | - Krijn P. van Lienden
- Department of Interventional Radiology, St Antonius Hospital, Nieuwegein, The Netherlands
| | - I. Quintus Molenaar
- Department of Surgery, Regional Academic Cancer Center Utrecht, University Medical Center Utrecht and St Antonius Hospital, Nieuwegein, The Netherlands
| | - Gijs A. Patijn
- Department of Surgery, Isala Hospital, Zwolle, The Netherlands
| | - Arjen M. Rijken
- Department of Surgery, Amphia Hospital, Breda, The Netherlands
| | - Theo M. Ruers
- Department of Surgery, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Cornelis Verhoef
- Department of Surgical Oncology and Gastrointestinal Surgery, Erasmus University Medical Center Cancer Institute, Rotterdam, The Netherlands
| | - Johannes H. W. de Wilt
- Department of Surgery, Radboud University Medical Center, Radboud University Nijmegen, Nijmegen, The Netherlands
| | - Rutger-Jan Swijnenburg
- Department of Surgery, Cancer Center Amsterdam, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, The Netherlands
| | - Cornelis J. A. Punt
- Department of Medical Oncology, Cancer Center Amsterdam, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, The Netherlands
- Department of Epidemiology, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Joost Huiskens
- Department of Health, SAS Institute B.V., Huizen, The Netherlands
| | - Geert Kazemier
- From the Department of Surgery, Cancer Center Amsterdam, Amsterdam University Medical Centers, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
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12
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Benefits of the multiplanar and volumetric analyses of pancreatic cancer using computed tomography. PLoS One 2020; 15:e0240318. [PMID: 33027288 PMCID: PMC7540900 DOI: 10.1371/journal.pone.0240318] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Accepted: 09/23/2020] [Indexed: 01/18/2023] Open
Abstract
Although pancreatic cancer tumors are irregularly shaped in terms of their three-dimensional (3D) structure, when T staging by imaging results, generally only the axial plane is used to measure the largest tumor diameter. We investigated the size of pancreatic cancer tumors using multi-plane and 3D reconstructed computed tomography (CT) images and investigated their clinical usefulness. Patients who underwent surgery for pancreatic adenocarcinoma were included. We measured the largest diameter of each pancreatic tumor in the axial, coronal, and sagittal planes of CT images. In addition, maximal diameter and cancer volume were measured from 3D images that were constructed using a semi-automated software system. Final data were compared with pathologic examination and the effect of each value on prognosis was analyzed. A total of 183 patients were analyzed. The maximal diameters measured on the axial, coronal, and sagittal planes were 2.9 ± 1.1, 3.2 ± 0.9, and 3.2 ± 1.0 cm, respectively, which were significantly smaller than pathologic results (3.4 ± 1.4 cm, all p<0.05 by paired t-test). The longest diameter among them (3.4 ± 1.1 cm) was nearly similar to the pathologic diameter. Cancer volume measured on 3D images demonstrated a higher area under the receptor operating characteristic curve [0.714, (95% confidence interval: 0.640–0.788)] for predicting early death compared to any unidimensional CT diameters measured. The longest pancreatic tumor diameter measured on multiplanar CT images was most accurate when compared to its corresponding pathologic diameter. Tumor volume had a stronger correlation with overall survival than tumor diameter.
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13
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Impact of ultra-low dose CT acquisition on semi-automated RECIST tool in the evaluation of malignant focal liver lesions. Diagn Interv Imaging 2020; 101:473-479. [DOI: 10.1016/j.diii.2020.05.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2020] [Revised: 05/05/2020] [Accepted: 05/06/2020] [Indexed: 12/21/2022]
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14
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An observational study to justify and plan a future phase III randomized controlled trial of metformin in improving overall survival in patients with inoperable pancreatic cancer without liver metastases. J Cancer Res Clin Oncol 2020; 146:1369-1375. [PMID: 32157435 DOI: 10.1007/s00432-020-03177-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2019] [Accepted: 03/03/2020] [Indexed: 02/07/2023]
Abstract
PURPOSE Metformin has plausible direct and indirect anti-cancer properties against pancreatic adenocarcinoma cells. However, metformin may only be efficacious in patients with inoperable pancreatic ductal adenocarcinoma (PDAC) without liver metastases. Absorption may be decreased by gastrointestinal symptoms and proton pump inhibitors (PPIs). We aimed to justify and inform a future phase III trial of metformin versus placebo on survival in inoperable PDAC by documenting prevalence of patients meeting eligibility criteria, gastrointestinal symptoms and PPI use. METHODS Patient notes with PDAC were reviewed at a large teaching hospital over 2 years. Study variables were obtained from multiple sources of information. RESULTS 141 participants were identified (51.8% female), of which 37.6% were not prescribed metformin at diagnosis and had no radiological hepatic metastases. Characteristics were similar between non-metformin and metformin users. In eligible patients, 65.2% reported nausea and vomiting and 46.2% were prescribed PPIs. CONCLUSION Approximately, a third of all patients with inoperable PDAC are eligible for a future trial of metformin, allowing an estimate of the number of hospitals required for recruitment. Nausea and vomiting are common and should be managed effectively to prevent trial dropouts. PPI use is frequent and their influence on metformin's pharmacodynamic actions needs to be clarified.
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15
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Hazhirkarzar B, Khoshpouri P, Shaghaghi M, Ghasabeh MA, Pawlik TM, Kamel IR. Current state of the art imaging approaches for colorectal liver metastasis. Hepatobiliary Surg Nutr 2020; 9:35-48. [PMID: 32140477 DOI: 10.21037/hbsn.2019.05.11] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
One of the most common cancers worldwide, colorectal cancer (CRC) has been associated with significant morbidity and mortality and therefore represents an enormous burden to the health care system. Recent advances in CRC treatments have provided patients with primary and metastatic CRC a better long-term prognosis. The presence of synchronous or metachronous metastasis has been associated, however, with worse survival. The most common site of metastatic disease is the liver. A variety of treatment modalities aimed at targeting colorectal liver metastases (CRLM) has been demonstrated to improve the prognosis of these patients. Loco-regional approaches such as surgical resection and tumor ablation (operative and percutaneous) can provide patients with a chance at long-term disease control and even cure in select populations. Patient selection is important in defining the most suitable treatment option for CRLM in order to provide the best possible survival benefit while avoiding unnecessary interventions and adverse events. Medical imaging plays a crucial role in evaluating the characteristics of CRLMs and disease resectability. Size of tumors, proximity to adjacent anatomical structures, and volume of the unaffected liver are among the most important imaging parameters to determine the suitability of patients for surgical management or other appropriate treatment approaches. We herein provide a comprehensive overview of current-state-of-the-art imaging in the management of CRLM, including staging, treatment planning, response and survival assessment, and post-treatment surveillance. Computed tomography (CT) scan and magnetic resonance imaging (MRI) are two most commonly used techniques, which can be used solely or in combination with functional imaging modalities such as positron emission tomography (PET) and diffusion weighted imaging (DWI). Providing up-to-date evidence on advantages and disadvantages of imaging modalities and tumor assessment criteria, the current review offers a practice guide to assist providers in choosing the most suitable imaging approach for patients with CRLM.
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Affiliation(s)
- Bita Hazhirkarzar
- Russell H. Morgan Department of Radiology and Radiological Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Pegah Khoshpouri
- Russell H. Morgan Department of Radiology and Radiological Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Mohammadreza Shaghaghi
- Russell H. Morgan Department of Radiology and Radiological Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Mounes Aliyari Ghasabeh
- Russell H. Morgan Department of Radiology and Radiological Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Timothy M Pawlik
- Department of Surgery, The Ohio State University, Wexner Medical Center, Columbus, OH, USA
| | - Ihab R Kamel
- Russell H. Morgan Department of Radiology and Radiological Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA
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Vorontsov E, Cerny M, Régnier P, Di Jorio L, Pal CJ, Lapointe R, Vandenbroucke-Menu F, Turcotte S, Kadoury S, Tang A. Deep Learning for Automated Segmentation of Liver Lesions at CT in Patients with Colorectal Cancer Liver Metastases. Radiol Artif Intell 2019; 1:180014. [PMID: 33937787 DOI: 10.1148/ryai.2019180014] [Citation(s) in RCA: 52] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2018] [Revised: 01/25/2019] [Accepted: 01/31/2019] [Indexed: 02/06/2023]
Abstract
Purpose To evaluate the performance, agreement, and efficiency of a fully convolutional network (FCN) for liver lesion detection and segmentation at CT examinations in patients with colorectal liver metastases (CLMs). Materials and Methods This retrospective study evaluated an automated method using an FCN that was trained, validated, and tested with 115, 15, and 26 contrast material-enhanced CT examinations containing 261, 22, and 105 lesions, respectively. Manual detection and segmentation by a radiologist was the reference standard. Performance of fully automated and user-corrected segmentations was compared with that of manual segmentations. The interuser agreement and interaction time of manual and user-corrected segmentations were assessed. Analyses included sensitivity and positive predictive value of detection, segmentation accuracy, Cohen κ, Bland-Altman analyses, and analysis of variance. Results In the test cohort, for lesion size smaller than 10 mm (n = 30), 10-20 mm (n = 35), and larger than 20 mm (n = 40), the detection sensitivity of the automated method was 10%, 71%, and 85%; positive predictive value was 25%, 83%, and 94%; Dice similarity coefficient was 0.14, 0.53, and 0.68; maximum symmetric surface distance was 5.2, 6.0, and 10.4 mm; and average symmetric surface distance was 2.7, 1.7, and 2.8 mm, respectively. For manual and user-corrected segmentation, κ values were 0.42 (95% confidence interval: 0.24, 0.63) and 0.52 (95% confidence interval: 0.36, 0.72); normalized interreader agreement for lesion volume was -0.10 ± 0.07 (95% confidence interval) and -0.10 ± 0.08; and mean interaction time was 7.7 minutes ± 2.4 (standard deviation) and 4.8 minutes ± 2.1 (P < .001), respectively. Conclusion Automated detection and segmentation of CLM by using deep learning with convolutional neural networks, when manually corrected, improved efficiency but did not substantially change agreement on volumetric measurements.© RSNA, 2019Supplemental material is available for this article.
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Affiliation(s)
- Eugene Vorontsov
- Department of Radiology (M.C., A.T.) and Department of Surgery, Hepatopancreatobiliary and Liver Transplantation Division (R.L., F.V., S.T.), Centre Hospitalier de l'Université de Montréal (CHUM), 1000 rue Saint-Denis, Montréal, QC, Canada H2X 0C2; Montreal Institute for Learning Algorithms (MILA), Montréal, Canada (E.V., C.J.P.); École Polytechnique, Montréal, Canada (E.V., C.J.P., S.K.); Centre de Recherche du Centre Hospitalier de l'Université de Montréal (CRCHUM), Montréal, Canada (M.C., P.R., S.T., S.K., A.T.); and Imagia Cybernetics, Montréal, Canada (L.D.J.)
| | - Milena Cerny
- Department of Radiology (M.C., A.T.) and Department of Surgery, Hepatopancreatobiliary and Liver Transplantation Division (R.L., F.V., S.T.), Centre Hospitalier de l'Université de Montréal (CHUM), 1000 rue Saint-Denis, Montréal, QC, Canada H2X 0C2; Montreal Institute for Learning Algorithms (MILA), Montréal, Canada (E.V., C.J.P.); École Polytechnique, Montréal, Canada (E.V., C.J.P., S.K.); Centre de Recherche du Centre Hospitalier de l'Université de Montréal (CRCHUM), Montréal, Canada (M.C., P.R., S.T., S.K., A.T.); and Imagia Cybernetics, Montréal, Canada (L.D.J.)
| | - Philippe Régnier
- Department of Radiology (M.C., A.T.) and Department of Surgery, Hepatopancreatobiliary and Liver Transplantation Division (R.L., F.V., S.T.), Centre Hospitalier de l'Université de Montréal (CHUM), 1000 rue Saint-Denis, Montréal, QC, Canada H2X 0C2; Montreal Institute for Learning Algorithms (MILA), Montréal, Canada (E.V., C.J.P.); École Polytechnique, Montréal, Canada (E.V., C.J.P., S.K.); Centre de Recherche du Centre Hospitalier de l'Université de Montréal (CRCHUM), Montréal, Canada (M.C., P.R., S.T., S.K., A.T.); and Imagia Cybernetics, Montréal, Canada (L.D.J.)
| | - Lisa Di Jorio
- Department of Radiology (M.C., A.T.) and Department of Surgery, Hepatopancreatobiliary and Liver Transplantation Division (R.L., F.V., S.T.), Centre Hospitalier de l'Université de Montréal (CHUM), 1000 rue Saint-Denis, Montréal, QC, Canada H2X 0C2; Montreal Institute for Learning Algorithms (MILA), Montréal, Canada (E.V., C.J.P.); École Polytechnique, Montréal, Canada (E.V., C.J.P., S.K.); Centre de Recherche du Centre Hospitalier de l'Université de Montréal (CRCHUM), Montréal, Canada (M.C., P.R., S.T., S.K., A.T.); and Imagia Cybernetics, Montréal, Canada (L.D.J.)
| | - Christopher J Pal
- Department of Radiology (M.C., A.T.) and Department of Surgery, Hepatopancreatobiliary and Liver Transplantation Division (R.L., F.V., S.T.), Centre Hospitalier de l'Université de Montréal (CHUM), 1000 rue Saint-Denis, Montréal, QC, Canada H2X 0C2; Montreal Institute for Learning Algorithms (MILA), Montréal, Canada (E.V., C.J.P.); École Polytechnique, Montréal, Canada (E.V., C.J.P., S.K.); Centre de Recherche du Centre Hospitalier de l'Université de Montréal (CRCHUM), Montréal, Canada (M.C., P.R., S.T., S.K., A.T.); and Imagia Cybernetics, Montréal, Canada (L.D.J.)
| | - Réal Lapointe
- Department of Radiology (M.C., A.T.) and Department of Surgery, Hepatopancreatobiliary and Liver Transplantation Division (R.L., F.V., S.T.), Centre Hospitalier de l'Université de Montréal (CHUM), 1000 rue Saint-Denis, Montréal, QC, Canada H2X 0C2; Montreal Institute for Learning Algorithms (MILA), Montréal, Canada (E.V., C.J.P.); École Polytechnique, Montréal, Canada (E.V., C.J.P., S.K.); Centre de Recherche du Centre Hospitalier de l'Université de Montréal (CRCHUM), Montréal, Canada (M.C., P.R., S.T., S.K., A.T.); and Imagia Cybernetics, Montréal, Canada (L.D.J.)
| | - Franck Vandenbroucke-Menu
- Department of Radiology (M.C., A.T.) and Department of Surgery, Hepatopancreatobiliary and Liver Transplantation Division (R.L., F.V., S.T.), Centre Hospitalier de l'Université de Montréal (CHUM), 1000 rue Saint-Denis, Montréal, QC, Canada H2X 0C2; Montreal Institute for Learning Algorithms (MILA), Montréal, Canada (E.V., C.J.P.); École Polytechnique, Montréal, Canada (E.V., C.J.P., S.K.); Centre de Recherche du Centre Hospitalier de l'Université de Montréal (CRCHUM), Montréal, Canada (M.C., P.R., S.T., S.K., A.T.); and Imagia Cybernetics, Montréal, Canada (L.D.J.)
| | - Simon Turcotte
- Department of Radiology (M.C., A.T.) and Department of Surgery, Hepatopancreatobiliary and Liver Transplantation Division (R.L., F.V., S.T.), Centre Hospitalier de l'Université de Montréal (CHUM), 1000 rue Saint-Denis, Montréal, QC, Canada H2X 0C2; Montreal Institute for Learning Algorithms (MILA), Montréal, Canada (E.V., C.J.P.); École Polytechnique, Montréal, Canada (E.V., C.J.P., S.K.); Centre de Recherche du Centre Hospitalier de l'Université de Montréal (CRCHUM), Montréal, Canada (M.C., P.R., S.T., S.K., A.T.); and Imagia Cybernetics, Montréal, Canada (L.D.J.)
| | - Samuel Kadoury
- Department of Radiology (M.C., A.T.) and Department of Surgery, Hepatopancreatobiliary and Liver Transplantation Division (R.L., F.V., S.T.), Centre Hospitalier de l'Université de Montréal (CHUM), 1000 rue Saint-Denis, Montréal, QC, Canada H2X 0C2; Montreal Institute for Learning Algorithms (MILA), Montréal, Canada (E.V., C.J.P.); École Polytechnique, Montréal, Canada (E.V., C.J.P., S.K.); Centre de Recherche du Centre Hospitalier de l'Université de Montréal (CRCHUM), Montréal, Canada (M.C., P.R., S.T., S.K., A.T.); and Imagia Cybernetics, Montréal, Canada (L.D.J.)
| | - An Tang
- Department of Radiology (M.C., A.T.) and Department of Surgery, Hepatopancreatobiliary and Liver Transplantation Division (R.L., F.V., S.T.), Centre Hospitalier de l'Université de Montréal (CHUM), 1000 rue Saint-Denis, Montréal, QC, Canada H2X 0C2; Montreal Institute for Learning Algorithms (MILA), Montréal, Canada (E.V., C.J.P.); École Polytechnique, Montréal, Canada (E.V., C.J.P., S.K.); Centre de Recherche du Centre Hospitalier de l'Université de Montréal (CRCHUM), Montréal, Canada (M.C., P.R., S.T., S.K., A.T.); and Imagia Cybernetics, Montréal, Canada (L.D.J.)
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Combined Volumetric and Density Analyses of Contrast-Enhanced CT Imaging to Assess Drug Therapy Response in Gastroenteropancreatic Neuroendocrine Diffuse Liver Metastasis. CONTRAST MEDIA & MOLECULAR IMAGING 2018; 2018:6037273. [PMID: 30510495 PMCID: PMC6230417 DOI: 10.1155/2018/6037273] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/08/2018] [Revised: 08/09/2018] [Accepted: 09/25/2018] [Indexed: 01/23/2023]
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.
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Locally advanced gastric cancer: total iodine uptake to predict the response of primary lesion to neoadjuvant chemotherapy. J Cancer Res Clin Oncol 2018; 144:2207-2218. [PMID: 30094537 DOI: 10.1007/s00432-018-2728-z] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2018] [Accepted: 07/30/2018] [Indexed: 12/22/2022]
Abstract
PURPOSE Pathologic response to neoadjuvant chemotherapy is a prognostic factor in many cancer types. However, the existing evaluative criteria are deficient. We sought to prospectively evaluate the total iodine uptake derived from dual-energy computed tomography (DECT) in predicting treatment efficacy and progression-free survival (PFS) time in gastric cancer after neoadjuvant chemotherapy. METHODS From October 2012 to December 2015, 44 patients with locally advanced gastric cancer were examined with DECT 1 week before and three cycles after neoadjuvant chemotherapy. The percentage changes in tumor area (%ΔS), diameter (%ΔD), and density (%ΔHU) were calculated to evaluate the WHO, RESCIST, and Choi criteria. The percentage changes in tumor volume (%ΔV) and total iodine uptake of portal phase (%ΔTIU-p) were also calculated to determine cut-off values by ROC curves. The correlation between the different criteria and histopathologic tumor regression grade (Becker score) or PFS were statistically analyzed. RESULTS Forty-four patients were divided into responders and non-responders according to 43.34% volume reduction (P = 0.002) and 63.87% (P = 0.002) TIU-p reduction, respectively. The %ΔTIU-p showed strong (r = 0.602, P = 0.000) and %ΔV showed moderate (r = 0.416, P = 0.005), while the WHO (r = 0.075, P = 0.627), RECIST (r = 0.270, P = 0.077) and Choi criteria (r = 0.238, P = 0.120) showed no correlation with the Becker score. The differences in PFS time between the responder and non-responder groups were significant according to %ΔTIU-p and Choi criteria (P = 0.001 and P = 0.013, respectively). CONCLUSIONS The TIU-p can help predict pathological regression in advanced gastric cancer patients after neoadjuvant chemotherapy. In addition, the %ΔTIU-p could be one of the potentially valuable predictive parameters of the PFS time.
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Towards volumetric thresholds in RECIST 1.1: Therapeutic response assessment in hepatic metastases. Eur Radiol 2018; 28:4839-4848. [DOI: 10.1007/s00330-018-5424-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2017] [Revised: 02/24/2018] [Accepted: 03/09/2018] [Indexed: 10/17/2022]
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Pupulim L, Ronot M, Paradis V, Chemouny S, Vilgrain V. Volumetric measurement of hepatic tumors: Accuracy of manual contouring using CT with volumetric pathology as the reference method. Diagn Interv Imaging 2018; 99:83-89. [DOI: 10.1016/j.diii.2017.11.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2017] [Revised: 10/31/2017] [Accepted: 11/19/2017] [Indexed: 01/16/2023]
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21
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Ghobrial FEI, Eldin MS, Razek AAKA, Atwan NI, Shamaa SSA. Computed Tomography Assessment of Hepatic Metastases of Breast Cancer with Revised Response Evaluation Criteria in Solid Tumors (RECIST) Criteria (Version 1.1): Inter-Observer Agreement. Pol J Radiol 2017; 82:593-597. [PMID: 29657622 PMCID: PMC5894063 DOI: 10.12659/pjr.902930] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2016] [Accepted: 01/24/2017] [Indexed: 12/29/2022] Open
Abstract
Background To assess inter-observer agreement of revised RECIST criteria (version 1.1) for computed tomography assessment of hepatic metastases of breast cancer. Material/Methods A prospective study was conducted in 28 female patients with breast cancer and with at least one measurable metastatic lesion in the liver that was treated with 3 cycles of anthracycline-based chemotherapy. All patients underwent computed tomography of the abdomen with 64-row multi- detector CT at baseline and after 3 cycles of chemotherapy for response assessment. Image analysis was performed by 2 observers, based on the RECIST criteria (version 1.1). Results Computed tomography revealed partial response of hepatic metastases in 7 patients (25%) by one observer and in 10 patients (35.7%) by the other observer, with good inter-observer agreement (k=0.75, percent agreement of 89.29%). Stable disease was detected in 19 patients (67.8%) by one observer and in 16 patients (57.1%) by the other observer, with good agreement (k=0.774, percent agreement of 89.29%). Progressive disease was detected in 2 patients (7.2%) by both observers, with perfect agreement (k=1, percent agreement of 100%). The overall inter-observer agreement in the CT-based response assessment of hepatic metastasis between the two observers was good (k=0.793, percent agreement of 89.29%). Conclusions We concluded that computed tomography is a reliable and reproducible imaging modality for response assessment of hepatic metastases of breast cancer according to the RECIST criteria (version 1.1).
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Affiliation(s)
- Fady Emil Ibrahim Ghobrial
- Department of Internal Medicine (Medical Oncology), Faculty of Medicine, Oncology Center Mansoura University, Mansoura, Egypt
| | - Manal Salah Eldin
- Department of Internal Medicine (Medical Oncology), Faculty of Medicine, Oncology Center Mansoura University, Mansoura, Egypt
| | | | - Nadia Ibrahim Atwan
- Department of Pathology, Faculty of Medicine, Mansoura University, Mansoura, Egypt
| | - Sameh Sayed Ahmed Shamaa
- Department of Internal Medicine (Medical Oncology), Faculty of Medicine, Oncology Center Mansoura University, Mansoura, Egypt
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Levine ZH, Chen-Mayer HH, Peskin AP, Pintar AL. Comparison of One-Dimensional and Volumetric Computed Tomography Measurements of Injected-Water Phantoms. JOURNAL OF RESEARCH OF THE NATIONAL INSTITUTE OF STANDARDS AND TECHNOLOGY 2017; 122:1-9. [PMID: 34877089 PMCID: PMC7339618 DOI: 10.6028/jres.122.036] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 08/23/2017] [Indexed: 06/13/2023]
Abstract
The goal of this study was to compare volumetric analysis in computed tomography (CT) with the length measurement prescribed by the Response Evaluation Criteria in Solid Tumors (RECIST) for a system with known mass and unknown shape. We injected 2 mL to 4 mL of water into vials of sodium polyacrylate and into disposable diapers. Volume measurements of the sodium polyacrylate powder were able to predict both mass and proportional changes in mass within a 95 % prediction interval of width 12 % and 16 %, respectively. The corresponding figures for RECIST were 102 % and 82 %.
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Affiliation(s)
- Zachary H Levine
- National Institute of Standards and Technology, Gaithersburg, Maryland 20899, USA
| | - H Heather Chen-Mayer
- National Institute of Standards and Technology, Gaithersburg, Maryland 20899, USA
| | - Adele P Peskin
- National Institute of Standards and Technology, Boulder, Colorado 80305, USA
| | - Adam L Pintar
- National Institute of Standards and Technology, Gaithersburg, Maryland 20899, USA
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Herrmann E, Naehrig D, Sassowsky M, Bigler M, Buijsen J, Ciernik I, Zwahlen D, Pellanda AF, Meister A, Brauchli P, Berardi S, Kuettel E, Dufour JF, Aebersold DM. External beam radiotherapy for unresectable hepatocellular carcinoma, an international multicenter phase I trial, SAKK 77/07 and SASL 26. Radiat Oncol 2017; 12:12. [PMID: 28086942 PMCID: PMC5237353 DOI: 10.1186/s13014-016-0745-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2016] [Accepted: 12/21/2016] [Indexed: 12/14/2022] Open
Abstract
PURPOSE To assess feasibility and safety of conventionally fractionated radiotherapy (cfRT) in patients with hepatocellular carcinoma (HCC). METHODS Patients with histologically confirmed stage cT1-4, cN0-1 HCC and Child-Pugh Score (CPS) A or B disease were included in a phase I multicenter trial. Metastatic HCC were allowed if ≥90% of total tumor volume was located within the liver. Patients were enrolled onto five dose-escalation levels (54-70Gy in 2Gy fractions) based on a modified 3 + 3 design, with cohorts of five patients instead of three patients in dose levels 4 and 5. Primary trial endpoint was dose-limiting toxicity (DLT), as specifically defined for 17 clinical and nine laboratory parameters as grade ≥3 or ≥4 toxicity (CTCAE vs. 3). The threshold to declare a dose level as maximum tolerated dose (MTD) was defined as a DLT rate of ≤16.7% in dose levels 1-3, and ≤10% in dose levels 4-5. Best objective response of target liver lesions and adverse events (AE's) were assessed as secondary endpoints. RESULTS The trial was terminated early in DL 3 due to low accrual. Nineteen patients were recruited. Fifteen patients were evaluable for the primary and 18 for the secondary endpoints. Maximum tolerated dose was not reached. One patient in dose level 1, and one patient in dose level 2 experienced DLT (lipase > 5xULN, and neutrophils <500/μL respectively). However, dose level 3 (62Gy) was completed, with no DLTs in 3 patients. Overall, 56% of patients had a partial response and 28% showed stable disease according to RECIST. No signs of radiation induced liver disease (RILD). Two patients in dose level 3 experienced lymphocytopenia grade 4, with no clinical impact. CONCLUSION Conventionally fractionated radiotherapy of 58Gy to even large HCC was safe for patients with CPS A and B. 62Gy was delivered to three patients without any sign of clinically relevant increased toxicity. The maximum tolerated dose could not be determined. TRIAL REGISTRATION ClinicalTrials.gov identifier NCT00777894 , registered October 21st, 2008.
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Affiliation(s)
- Evelyn Herrmann
- Department of Radiation Oncology, Inselspital, Bern University Hospital and University of Bern, Bern, Switzerland
| | - Diana Naehrig
- Division of Radiation Oncology, Basel University Hospital, Basel, Switzerland
- Department of Radiation Oncology, Lifehouse at RPA, Sydney, NSW Australia
| | - Manfred Sassowsky
- Department of Radiation Oncology and Division of Medical Radiation Physics, Bern University Hospital, Bern, Switzerland
| | | | - Jeroen Buijsen
- Department of Radiation Oncology (MAASTRO Clinic), GROW – School for Oncology and Developmental Biolog, Maastricht, The Netherlands
| | - Ilja Ciernik
- Department of Radiation Oncology, University of Zurich, Zurich, Switzerland
- Department of Radiotherapy and Radiation Oncology, Dessau City Hospital, Dessau, Germany
| | - Daniel Zwahlen
- Department of Radiation Oncology, Hospital Graubuenden, Chur, Switzerland
| | - Alessandra Franzetti Pellanda
- Radiation Oncology Department, Oncology Institute of Southern Switzerland, Bellinzona, Switzerland
- Radiotherapy Service, Clinica Luganese SA, Lugano, Switzerland
| | - Andreas Meister
- Centre for Radiation Oncology, KSA-KSB, Kantonsspital Aarau, Aarau, Switzerland
| | | | - Simona Berardi
- Department of Radiation Oncology and Division of Medical Radiation Physics, Bern University Hospital, Bern, Switzerland
| | | | - Jean-François Dufour
- Department of Hepatology, University Clinic of Visceral Surgery and Medicine, Inselspital, Bern University Hospital and University of Bern, Bern, Switzerland
| | - Daniel M. Aebersold
- Department of Radiation Oncology, Inselspital, Bern University Hospital and University of Bern, Bern, Switzerland
| | - for the Swiss Group for Clinical Cancer Research (SAKK)
- Department of Radiation Oncology, Inselspital, Bern University Hospital and University of Bern, Bern, Switzerland
- Division of Radiation Oncology, Basel University Hospital, Basel, Switzerland
- Department of Radiation Oncology, Lifehouse at RPA, Sydney, NSW Australia
- Department of Radiation Oncology and Division of Medical Radiation Physics, Bern University Hospital, Bern, Switzerland
- SAKK Coordinating Center, Bern, Switzerland
- Department of Radiation Oncology (MAASTRO Clinic), GROW – School for Oncology and Developmental Biolog, Maastricht, The Netherlands
- Department of Radiation Oncology, University of Zurich, Zurich, Switzerland
- Department of Radiotherapy and Radiation Oncology, Dessau City Hospital, Dessau, Germany
- Department of Radiation Oncology, Hospital Graubuenden, Chur, Switzerland
- Radiation Oncology Department, Oncology Institute of Southern Switzerland, Bellinzona, Switzerland
- Radiotherapy Service, Clinica Luganese SA, Lugano, Switzerland
- Centre for Radiation Oncology, KSA-KSB, Kantonsspital Aarau, Aarau, Switzerland
- Department of Hepatology, University Clinic of Visceral Surgery and Medicine, Inselspital, Bern University Hospital and University of Bern, Bern, Switzerland
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Stroehl YW, Letzen BS, van Breugel JMM, Geschwind JF, Chapiro J. Intra-arterial therapies for liver cancer: assessing tumor response. Expert Rev Anticancer Ther 2016; 17:119-127. [PMID: 27983883 DOI: 10.1080/14737140.2017.1273775] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
INTRODUCTION Intra-arterial therapies (IATs) play an integral role in the management of unresectable hepatocellular carcinoma and liver metastases. The ability to accurately assess tumor response to intra-arterial therapies is crucial for clinical management. Several one- and two-dimensional manual imaging-based response assessment techniques, based both on tumor size or enhancement, have shown to be highly subjective and merely surrogate for the actual tumor as a whole. Areas covered: Given the currently existing literature, we will discuss all available tumor assessment techniques and criteria for liver cancer with a strong emphasis on 3D quantitative imaging biomarkers of tumor response in this review. Expert commentary: The growing role of information technology in medicine has brought about the advent of software-assisted, segmentation-based assessment techniques that address the outstanding issues of a subjective reader and provide for more accurate assessment techniques for the locally treated lesions. Three-dimensional quantitative tumor assessment techniques are superior to one- and two-dimensional measurements. This allows for treatment alterations and more precise targeting, potentially resulting in improved patient outcome.
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Affiliation(s)
- Yasmin W Stroehl
- a Department of Diagnostic and Interventional Radiology , Charité , Berlin , Germany.,b Department of Radiology and Biomedical Imaging , Yale School of Medicine , New Haven , CT , USA
| | - Brian S Letzen
- b Department of Radiology and Biomedical Imaging , Yale School of Medicine , New Haven , CT , USA
| | - Johanna M M van Breugel
- b Department of Radiology and Biomedical Imaging , Yale School of Medicine , New Haven , CT , USA
| | - Jean-Francois Geschwind
- b Department of Radiology and Biomedical Imaging , Yale School of Medicine , New Haven , CT , USA
| | - Julius Chapiro
- b Department of Radiology and Biomedical Imaging , Yale School of Medicine , New Haven , CT , USA
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Dreizin D, Bodanapally UK, Neerchal N, Tirada N, Patlas M, Herskovits E. Volumetric analysis of pelvic hematomas after blunt trauma using semi-automated seeded region growing segmentation: a method validation study. Abdom Radiol (NY) 2016; 41:2203-2208. [PMID: 27349420 DOI: 10.1007/s00261-016-0822-8] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
OBJECTIVE Manually segmented traumatic pelvic hematoma volumes are strongly predictive of active bleeding at conventional angiography, but the method is time intensive, limiting its clinical applicability. We compared volumetric analysis using semi-automated region growing segmentation to manual segmentation and diameter-based size estimates in patients with pelvic hematomas after blunt pelvic trauma. MATERIALS AND METHODS A 14-patient cohort was selected in an anonymous randomized fashion from a dataset of patients with pelvic binders at MDCT, collected retrospectively as part of a HIPAA-compliant IRB-approved study from January 2008 to December 2013. To evaluate intermethod differences, one reader (R1) performed three volume measurements using the manual technique and three volume measurements using the semi-automated technique. To evaluate interobserver differences for semi-automated segmentation, a second reader (R2) performed three semi-automated measurements. One-way analysis of variance was used to compare differences in mean volumes. Time effort was also compared. Correlation between the two methods as well as two shorthand appraisals (greatest diameter, and the ABC/2 method for estimating ellipsoid volumes) was assessed with Spearman's rho (r). RESULTS Intraobserver variability was lower for semi-automated compared to manual segmentation, with standard deviations ranging between ±5-32 mL and ±17-84 mL, respectively (p = 0.0003). There was no significant difference in mean volumes between the two readers' semi-automated measurements (p = 0.83); however, means were lower for the semi-automated compared with the manual technique (manual: mean and SD 309.6 ± 139 mL; R1 semi-auto: 229.6 ± 88.2 mL, p = 0.004; R2 semi-auto: 243.79 ± 99.7 mL, p = 0.021). Despite differences in means, the correlation between the two methods was very strong and highly significant (r = 0.91, p < 0.001). Correlations with diameter-based methods were only moderate and nonsignificant. Mean semi-automated segmentation time effort was 2 min and 6 s and 2 min and 35 s for R1 and R2, respectively, vs. 22 min and 8 s for manual segmentation. CONCLUSION Semi-automated pelvic hematoma volumes correlate strongly with manually segmented volumes. Since semi-automated segmentation can be performed reliably and efficiently, volumetric analysis of traumatic pelvic hematomas is potentially valuable at the point-of-care.
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Affiliation(s)
- David Dreizin
- Department of Diagnostic Radiology and Nuclear Medicine, R Adams Cowley Shock Trauma Center, University of Maryland Medical Center, 22 South Greene Street, Baltimore, MD, 21201, USA.
| | - Uttam K Bodanapally
- Department of Diagnostic Radiology and Nuclear Medicine, R Adams Cowley Shock Trauma Center, University of Maryland Medical Center, 22 South Greene Street, Baltimore, MD, 21201, USA
| | - Nagaraj Neerchal
- Department of Mathematics and Statistics, University of Maryland, Baltimore County, 1000 Hilltop Circle, Baltimore, MD, 21250, USA
| | - Nikki Tirada
- Department of Radiology, Brigham and Women's Hospital, 75 Francis Street, Boston, MA, 02115, USA
| | - Michael Patlas
- Emergency Radiology Division, Department of Radiology, Hamilton General Hospital, 237 Barton Street, East Hamilton, ON, Canada
| | - Edward Herskovits
- Department of Diagnostic Radiology and Nuclear Medicine, R Adams Cowley Shock Trauma Center, University of Maryland Medical Center, 22 South Greene Street, Baltimore, MD, 21201, USA
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Reiter MJ, Hannemann NP, Schwope RB, Lisanti CJ, Learn PA. Role of imaging for patients with colorectal hepatic metastases: what the radiologist needs to know. ACTA ACUST UNITED AC 2016. [PMID: 26194812 DOI: 10.1007/s00261-015-0507-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Surgical resection of colorectal metastatic disease has increased as surgeons have adopted a more aggressive ideology. Current exclusion criteria are patients for whom a negative resection margin is not feasible or a future liver remnant (FLR) of greater than 20% is not achievable. The goal of preoperative imaging is to identify the number and distribution of liver metastases, in addition to establishing their relation to relevant intrahepatic structures. FLR can be calculated utilizing cross-sectional imaging to select out patients at risk for hepatic dysfunction after resection. MRI, specifically with gadoxetic acid contrast, is currently the preferred modality for assessment of hepatic involvement for patients with newly diagnosed colorectal cancer, to include those who have undergone neoadjuvant chemotherapy. Employment of liver-directed therapies has recently expanded and they may provide an alternative to hepatectomy in order to obtain locoregional control in poor surgical candidates or convert patients with initially unresectable disease into surgical candidates.
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Affiliation(s)
- Michael J Reiter
- Department of Radiology, Stony Brook University Medical Center, HSC Level 4, Room 120 East Loop Road, Stony Brook, NY, 11794, USA.
| | - Nathan P Hannemann
- Department of Radiology, Brooke Army Medical Center, San Antonio, TX, USA
| | - Ryan B Schwope
- Department of Radiology, Brooke Army Medical Center, San Antonio, TX, USA.,Uniformed Services University of the Health Sciences, Bethesda, MD, USA
| | - Christopher J Lisanti
- Department of Radiology, Brooke Army Medical Center, San Antonio, TX, USA.,Uniformed Services University of the Health Sciences, Bethesda, MD, USA
| | - Peter A Learn
- Department of Surgery, Brooke Army Medical Center, San Antonio, TX, USA
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Yan J, Schwartz LH, Zhao B. Semiautomatic segmentation of liver metastases on volumetric CT images. Med Phys 2016; 42:6283-93. [PMID: 26520721 DOI: 10.1118/1.4932365] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
PURPOSE Accurate segmentation and quantification of liver metastases on CT images are critical to surgery/radiation treatment planning and therapy response assessment. To date, there are no reliable methods to perform such segmentation automatically. In this work, the authors present a method for semiautomatic delineation of liver metastases on contrast-enhanced volumetric CT images. METHODS The first step is to manually place a seed region-of-interest (ROI) in the lesion on an image. This ROI will (1) serve as an internal marker and (2) assist in automatically identifying an external marker. With these two markers, lesion contour on the image can be accurately delineated using traditional watershed transformation. Density information will then be extracted from the segmented 2D lesion and help determine the 3D connected object that is a candidate of the lesion volume. The authors have developed a robust strategy to automatically determine internal and external markers for marker-controlled watershed segmentation. By manually placing a seed region-of-interest in the lesion to be delineated on a reference image, the method can automatically determine dual threshold values to approximately separate the lesion from its surrounding structures and refine the thresholds from the segmented lesion for the accurate segmentation of the lesion volume. This method was applied to 69 liver metastases (1.1-10.3 cm in diameter) from a total of 15 patients. An independent radiologist manually delineated all lesions and the resultant lesion volumes served as the "gold standard" for validation of the method's accuracy. RESULTS The algorithm received a median overlap, overestimation ratio, and underestimation ratio of 82.3%, 6.0%, and 11.5%, respectively, and a median average boundary distance of 1.2 mm. CONCLUSIONS Preliminary results have shown that volumes of liver metastases on contrast-enhanced CT images can be accurately estimated by a semiautomatic segmentation method.
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Affiliation(s)
- Jiayong Yan
- Department of Biomedical Engineering, Shanghai University of Medicine & Health Sciences, 101 Yingkou Road, Yang Pu District, Shanghai 200093, China
| | - Lawrence H Schwartz
- Department of Radiology, Columbia University Medical Center, 630 West 168th Street, New York, New York 10032
| | - Binsheng Zhao
- Department of Radiology, Columbia University Medical Center, 630 West 168th Street, New York, New York 10032
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28
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Fernández-Aceñero MJ, Cortés D, Gómez del Pulgar T, Cebrián A, Estrada L, Martínez-Useros J, Celdrán A, García-Foncillas J, Pastor C. PLK-1 Expression is Associated with Histopathological Response to Neoadjuvant Therapy of Hepatic Metastasis of Colorectal Carcinoma. Pathol Oncol Res 2016; 22:377-83. [PMID: 26577686 DOI: 10.1007/s12253-015-0015-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2015] [Accepted: 11/12/2015] [Indexed: 01/05/2023]
Abstract
Polo-like kinase 1 (PLK1) is a serine/threonine-protein kinase expressed during mitosis and overexpressed in multiple human cancers, including leukemia and also many solid tumors. PLK1 knockdown has been shown to block proliferation of leukemic cell lines and the clonogenic potential of tumor cells grown from patients with cancer. PLK1 inhibition is a promising strategy for the treatment of some tumors. We aim to analyze expression of PLK1 in metastatic colorectal carcinoma. Retrospective analysis of colorectal carcinomas with hepatic metastasis during follow-up receiving neoadjuvant chemotherapy (NAC), based on oxaliplatin. Immunohistochemistry for PLK-1 in paraffin-embedded tissue from the primary and also from the metastasis. 50 patients. 32% showed good histopathological response. 43% of the primaries were positive for PLK1, as opposed to 23.5% of the metastasis. Expression of PLK1 was significantly reduced in metastasis compared with the primaries (p = 0.05), what could be due to therapy or to a phenotypic change of the metastatic nodule. Analysis of the prognostic influence of PLK1 expression showed significant association between PLK1 expression in metastasis and lower overall survival (p = 0.000). We have also found a significant association between PLK1 expression and histopathological response (p = 0.02). All the tumors with high expression of PLK1 showed minor response (11/11). This study shows the association between survival and poor histopathological response to therapy and high expression of PLK1 in metastasis. Our results could open a new therapeutic approach through the inhibition of PLK1.
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Affiliation(s)
- M J Fernández-Aceñero
- Department of Surgical Pathology, Hospital Clínico San Carlos, C/ Profesor Martín Lagos s/n, 28040, Madrid, Spain.
| | - D Cortés
- Department of Surgery, Health Research Institute FJD-UAM, University Hospital Fundación Jiménez Diaz, Madrid, Spain
| | - T Gómez del Pulgar
- Translational Oncology Division, Oncohealth Institute, Health Research Institute FJD-UAM, University Hospital Fundación Jiménez Diaz, Madrid, Spain
| | - A Cebrián
- Translational Oncology Division, Oncohealth Institute, Health Research Institute FJD-UAM, University Hospital Fundación Jiménez Diaz, Madrid, Spain
| | - L Estrada
- Department of Surgical Pathology, Hospital Clínico San Carlos, C/ Profesor Martín Lagos s/n, 28040, Madrid, Spain
| | - J Martínez-Useros
- Translational Oncology Division, Oncohealth Institute, Health Research Institute FJD-UAM, University Hospital Fundación Jiménez Diaz, Madrid, Spain
| | - A Celdrán
- Department of Surgery, Health Research Institute FJD-UAM, University Hospital Fundación Jiménez Diaz, Madrid, Spain
| | - J García-Foncillas
- Translational Oncology Division, Oncohealth Institute, Health Research Institute FJD-UAM, University Hospital Fundación Jiménez Diaz, Madrid, Spain
| | - C Pastor
- Department of Surgery, Health Research Institute FJD-UAM, University Hospital Fundación Jiménez Diaz, Madrid, Spain
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Hoogenboom TC, Thursz M, Aboagye EO, Sharma R. Functional imaging of hepatocellular carcinoma. Hepat Oncol 2016; 3:137-153. [PMID: 30191034 DOI: 10.2217/hep-2015-0005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2015] [Accepted: 01/20/2016] [Indexed: 02/06/2023] Open
Abstract
Imaging plays a key role in the clinical management of hepatocellular carcinoma (HCC), but conventional imaging techniques have limited sensitivity in visualizing small tumors and assessing response to locoregional treatments and sorafenib. Functional imaging techniques allow visualization of organ and tumor physiology. Assessment of functional characteristics of tissue, such as metabolism, proliferation and stiffness, may overcome some of the limitations of structural imaging. In particular, novel molecular imaging agents offer a potential tool for early diagnosis of HCC, and radiomics may aid in response assessment and generate prognostic models. Further prospective research is warranted to evaluate emerging techniques and their cost-effectiveness in the context of HCC in order to improve detection and response assessment.
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Affiliation(s)
- Tim Ch Hoogenboom
- Department of Experimental Medicine, Imperial College London, Hammersmith Hospital, Du Cane Road, London, W12 0HS, UK.,Department of Experimental Medicine, Imperial College London, Hammersmith Hospital, Du Cane Road, London, W12 0HS, UK
| | - Mark Thursz
- Department of Hepatology, Imperial College NHS Trust, 10th Floor, Norfolk Place, St Mary's Hospital, London, UK.,Department of Hepatology, Imperial College NHS Trust, 10th Floor, Norfolk Place, St Mary's Hospital, London, UK
| | - Eric O Aboagye
- Comprehensive Cancer Imaging Centre at Imperial College, Faculty of Medicine, Imperial College London, GN1, Ground Floor, Commonwealth building, Hammersmith Campus, London, UK.,Comprehensive Cancer Imaging Centre at Imperial College, Faculty of Medicine, Imperial College London, GN1, Ground Floor, Commonwealth building, Hammersmith Campus, London, UK
| | - Rohini Sharma
- Department of Experimental Medicine, Imperial College London, Hammersmith Hospital, Du Cane Road, London, W12 0HS, UK.,Department of Experimental Medicine, Imperial College London, Hammersmith Hospital, Du Cane Road, London, W12 0HS, UK
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30
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Morphological aspects of the hepatic response to neoadjuvant therapy. Pathol Res Pract 2015; 211:665-70. [PMID: 26163186 DOI: 10.1016/j.prp.2015.06.007] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2015] [Revised: 05/19/2015] [Accepted: 06/10/2015] [Indexed: 12/20/2022]
Abstract
INTRODUCTION Therapy of metastatic colorectal carcinoma has greatly evolved in recent years. Surgery is still the best curative option and can improve survival in stage IV disease. Neoadjuvant chemotherapy (NAC) has emerged as a widely used therapeutic option before surgery. Pathologists have developed several systems to grade response, mainly adapting the grading systems used for the response in primary esophageal or rectal tumors. There are many reports confirming the prognostic utility of these grading systems. However, there have been fewer references to the potential significance of the pattern of histological response. The objective of the present study is to describe the histopathological lesions found in the tumor bed after NAC and their potential significance in terms of prognosis. MATERIAL AND METHODS We reviewed the files of patients with colorectal carcinoma that developed hepatic metastasis during follow-up and received NAC before surgical resection of metastasis. We gathered demographic, analytical and morphological data of the cases, and also reviewed the hepatic resection samples to measure the pathological response to chemotherapy according to Blazer's criteria, and to define the predominant patterns of response (mucin pools, fibrosis or necrosis). We also determined the presence of satellitosis, measured the thickness of the tumor-normal interface (TNI) as proposed by Maru et al., and searched for vascular and bile duct invasion. All these pieces of information were collected in an Excel database and analyzed with SPSS 20.0 for Windows statistical package. The outcome measures were disease-free survival and overall survival in months since the first surgery to resect metastatic disease. RESULTS Fifty patients fulfilled the inclusion criteria for the present study. All of them had received a chemotherapeutic regimen mainly based on platinum, associated or not with targeted drugs (18% received anti-EGFR drugs and 24% anti-VEGFR drugs). Of the primaries, 66% were of sigmoid-rectal origin, and 32% of the cases showed a major histopathological response to therapy (including 3 cases with a complete response). In 76% of the tumors, the predominant histological pattern was necrosis, followed by fibrosis (57.4%). Mucin pools were the predominant feature in 23.4% of the tumors. We found satellitosis (microscopic tumor nodules separated by more than 1mm from the principal tumor) in 53.2% of the cases. A prominent inflammatory reaction was found in 19% of the cases, and it was mainly composed of lymphocytes and hystiocytes (70% of the cases). Vessel invasion was seen in 30% of the cases, and perineural invasion was only found in 4%. We found no case of bile duct invasion by the tumor. The thickness of the TNI measured less than 2.5mm in 60% of the present series. Statistical analysis of the series revealed that thickness of the tumor-liver interface was significantly associated with recurrence and overall survival. We found a significant association between response and thickness of the tumor-normal liver interface. In our series, the presence of satellitosis tended to predict a shorter DFS. The comparison of Kaplan-Meier curves with the log-rank test showed a significant association between overall survival and the presence of mucin pools and fibrosis in the tumor bed. The other histopathological factors did not predict differences in prognosis. These differences were independent of the use of targeted drugs. DISCUSSION The pathological reports of hepatic metastasis from colorectal carcinoma resected after NAC usually indicate only the number, the size and the response of the tumor cells to therapy, apart from the distance to the resection margin of the specimen. Few reports have analyzed the possible prognostic significance of the different kinds of histopathological responses. The results of the present study indicate that those tumors with extensive pools of mucin show a significantly worse prognosis as compared to tumors with less mucin secretion. Fibrosis indicates a better prognosis, except when desmoplasia is present. Our study further supports the prognostic significance of the thickness of the tumor-hepatic interface. We conclude that pathology reports should specify the kind of histopathological response to therapy, besides grading it, because this might add significant prognostic information.
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Abstract
GI cancers are a heterogeneous group of neoplasms that differ in their biologic and physical behaviors depending on the organ of origin, location within the organ, and degree of differentiation. As a result, evaluation of these tumors is complex, requiring integration of information from a patient's clinical history, physical examination, laboratory data, and imaging. With advances in anatomic and functional imaging techniques, we now have tools for assessing patients with these tumors at diagnosis, staging, and treatment assessment. It is difficult for a single imaging modality to provide all the necessary information for a given GI tumor. However, well-chosen combinations of available imaging modalities based on the indications, strength, and limitations of the modalities will provide optimal evaluation of patients with these malignancies.
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32
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Rothe JH, Rudolph I, Rohwer N, Kupitz D, Gregor-Mamoudou B, Derlin T, Furth C, Amthauer H, Brenner W, Buchert R, Cramer T, Apostolova I. Time course of contrast enhancement by micro-CT with dedicated contrast agents in normal mice and mice with hepatocellular carcinoma: comparison of one iodinated and two nanoparticle-based agents. Acad Radiol 2015; 22:169-78. [PMID: 25282584 DOI: 10.1016/j.acra.2014.07.022] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2014] [Revised: 07/27/2014] [Accepted: 07/28/2014] [Indexed: 11/16/2022]
Abstract
RATIONALE AND OBJECTIVES The aim of the present study was to characterize the kinetics of two nanoparticle-based contrast agents for preclinical imaging, Exitron nano 6000 and Exitron nano 12000, and the iodinated agent eXIA 160 in both healthy mice and in a mouse model of hepatocellular carcinoma (HCC). Semiautomatic segmentation of liver lesions for estimation of total tumor load of the liver was evaluated in HCC mice. MATERIALS AND METHODS The normal time course of contrast enhancement was assessed in 15 healthy C57BL/6 mice. Imaging of tumor spread in the liver was evaluated in 15 mice harboring a transgenic HCC model (ASV-B mice). Automatic segmentation of liver lesions for determination of total tumor burden of the liver was tested in three additional ASV-B mice before and after an experimental therapy. RESULTS In healthy mice, clearance of the contrast agent from blood was completed within 3-4 hours for eXIA 160 and Exitron nano 6000, whereas complete blood clearance of Exitron nano 12000 required about 24 hours. eXIA 160 provided maximum liver contrast at 1 hour post injection (p.i.) followed by a continuous decline. Enhancement of liver contrast with Exitron nano 6000 and Exitron nano 12000 reached a plateau at about 4 hours p.i., which lasted until the end of the measurements at 96 hours p.i. Maximum contrast enhancement of the liver was not statistically different between Exitron nano 6000 and Exitron nano 12000, but was about three times lower for eXIA 160 (P < .05). Visually Exitron nano 12000 provided the best liver-to-tumor contrast. Semiautomatic liver and tumor segmentation was feasible after the administration of Exitron nano 12000 but did not work properly for the other two contrast agents. CONCLUSIONS Both nanoparticle-based contrast agents provided stronger and longer lasting contrast enhancement of healthy liver parenchyma. Exitron nano 12000 allowed automatic segmentation of tumor lesions for estimation of the total tumor load in the liver.
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Affiliation(s)
- Jan H Rothe
- Clinic of Nuclear Medicine, University Medicine Charité, Berlin, Germany
| | - Ines Rudolph
- Clinic of Hepatology and Gastroenterology, University Medicine Charité, Berlin, Germany; German Cancer Consortium, Deutsches Krebsforschungzentrum (DKFZ), Heidelberg, Germany
| | - Nadine Rohwer
- Clinic of Hepatology and Gastroenterology, University Medicine Charité, Berlin, Germany
| | - Dennis Kupitz
- Department of Radiology and Nuclear Medicine, Medical School, Otto-von-Guericke University, Magdeburg A.ö.R., Magdeburg, Germany
| | | | - Thorsten Derlin
- Clinic of Radiology, University Medical Center, Hamburg, Germany
| | - Christian Furth
- Department of Radiology and Nuclear Medicine, Medical School, Otto-von-Guericke University, Magdeburg A.ö.R., Magdeburg, Germany
| | - Holger Amthauer
- Department of Radiology and Nuclear Medicine, Medical School, Otto-von-Guericke University, Magdeburg A.ö.R., Magdeburg, Germany
| | - Winfried Brenner
- Clinic of Nuclear Medicine, University Medicine Charité, Berlin, Germany
| | - Ralph Buchert
- Clinic of Nuclear Medicine, University Medicine Charité, Berlin, Germany
| | - Thorsten Cramer
- Clinic of Hepatology and Gastroenterology, University Medicine Charité, Berlin, Germany
| | - Ivayla Apostolova
- Department of Radiology and Nuclear Medicine, Medical School, Otto-von-Guericke University, Magdeburg A.ö.R., Magdeburg, Germany.
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Chapiro J, Lin M, Duran R, Schernthaner RE, Geschwind JF. Assessing tumor response after loco-regional liver cancer therapies: the role of 3D MRI. Expert Rev Anticancer Ther 2014; 15:199-205. [PMID: 25371052 DOI: 10.1586/14737140.2015.978861] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
Assessing the tumor response of liver cancer lesions after intraarterial therapies is of major clinical interest. Over the last two decades, tumor response criteria have come a long way from purely size-based, anatomic methods such as the Response Evaluation Criteria in Solid Tumors towards more functional, enhancement- and diffusion-based parameters with a strong emphasis on MRI as the ultimate imaging modality. However, the relatively low reproducibility of those one- and 2D techniques (modified Response Evaluation Criteria in Solid Tumors and the European Association for the Study of the Liver criteria) provided the rationale for the development of new, 3D quantitative assessment techniques. This review will summarize and compare the existing methodologies used for 3D quantitative tumor analysis and provide an overview of the published clinical evidence for the benefits of 3D quantitative tumor response assessment techniques.
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Affiliation(s)
- Julius Chapiro
- The Russell H. Morgan Department of Radiology and Radiological Sciences, Division of Vascular and Interventional Radiology, The Johns Hopkins Hospital, Johns Hopkins University School of Medicine, 1800 Orleans Street, Sheikh Zayed Tower, Suite 7203, Baltimore, MD 21287, USA
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Nishino M, Jackman DM, DiPiro PJ, Hatabu H, Jänne PA, Johnson BE. Revisiting the relationship between tumour volume and diameter in advanced NSCLC patients: An exercise to maximize the utility of each measure to assess response to therapy. Clin Radiol 2014; 69:841-8. [PMID: 24857677 PMCID: PMC4105980 DOI: 10.1016/j.crad.2014.03.020] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2014] [Revised: 03/12/2014] [Accepted: 03/27/2014] [Indexed: 10/25/2022]
Abstract
AIM To revisit the presumed relationship between tumour diameter and volume in advanced non-small-cell lung cancer (NSCLC) patients, and determine whether the measured volume using volume-analysis software and its proportional changes during therapy matches with the calculated volume obtained from the presumed relationship and results in concordant response assessment. MATERIALS AND METHODS Twenty-three patients with stage IIIB/IV NSCLC with a total of 53 measurable lung lesions, treated in a phase II trial of erlotinib, were studied with institutional review board approval. Tumour volume and diameter were measured at baseline and at the first follow-up computed tomography (CT) examination using volume-analysis software. Using the measured diameter (2r) and the equation, calculated volume was obtained as (4/3)πr(3) at baseline and at the follow-up. Percent volume change was obtained by comparing to baseline for measured and calculated volumes, and response assessment was assigned. RESULTS The measured volume was significantly smaller than the calculated volume at baseline (median 11,488.9 mm(3) versus 17,148.6 mm(3); p < 0.0001), with a concordance correlation coefficient (CCC) of 0.7022. At follow-up, the measured volume was once again significantly smaller than the calculated volume (median 6573.5 mm(3) versus 9198.1 mm(3); p = 0.0022), with a CCC of 0.7408. Response assessment by calculated versus measured volume changes had only moderate agreement (weighted κ = 0.545), with discordant assessment results in 20% (8/40) of lesions. CONCLUSION Calculated volume based on the presumed relationship significantly differed from the measured volume in advanced NSCLC patients, with only moderate concordance in response assessment, indicating the limitations of presumed relationship.
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Affiliation(s)
- M Nishino
- Department of Radiology, Dana-Farber Cancer Institute and Brigham and Women's Hospital, 450 Brookline Ave., 75 Francis St., Boston, MA 02215, USA.
| | - D M Jackman
- Department of Medical Oncology and Department of Medicine, Dana-Farber Cancer Institute and Brigham and Women's Hospital, 450 Brookline Ave., Boston, MA 02215, USA
| | - P J DiPiro
- Department of Radiology, Dana-Farber Cancer Institute and Brigham and Women's Hospital, 450 Brookline Ave., 75 Francis St., Boston, MA 02215, USA
| | - H Hatabu
- Department of Radiology, Dana-Farber Cancer Institute and Brigham and Women's Hospital, 450 Brookline Ave., 75 Francis St., Boston, MA 02215, USA
| | - P A Jänne
- Department of Medical Oncology and Department of Medicine, Dana-Farber Cancer Institute and Brigham and Women's Hospital, 450 Brookline Ave., Boston, MA 02215, USA
| | - B E Johnson
- Department of Medical Oncology and Department of Medicine, Dana-Farber Cancer Institute and Brigham and Women's Hospital, 450 Brookline Ave., Boston, MA 02215, USA
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Vollherbst D, Fritz S, Zelzer S, Wachter MF, Wolf MB, Stampfl U, Gnutzmann D, Bellemann N, Schmitz A, Knapp J, Pereira PL, Kauczor HU, Werner J, Radeleff BA, Sommer CM. Specific CT 3D rendering of the treatment zone after Irreversible Electroporation (IRE) in a pig liver model: the "Chebyshev Center Concept" to define the maximum treatable tumor size. BMC Med Imaging 2014; 14:2. [PMID: 24410997 PMCID: PMC3926307 DOI: 10.1186/1471-2342-14-2] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2013] [Accepted: 12/30/2013] [Indexed: 12/18/2022] Open
Abstract
Background Size and shape of the treatment zone after Irreversible electroporation (IRE) can be difficult to depict due to the use of multiple applicators with complex spatial configuration. Exact geometrical definition of the treatment zone, however, is mandatory for acute treatment control since incomplete tumor coverage results in limited oncological outcome. In this study, the “Chebyshev Center Concept” was introduced for CT 3d rendering to assess size and position of the maximum treatable tumor at a specific safety margin. Methods In seven pig livers, three different IRE protocols were applied to create treatment zones of different size and shape: Protocol 1 (n = 5 IREs), Protocol 2 (n = 5 IREs), and Protocol 3 (n = 5 IREs). Contrast-enhanced CT was used to assess the treatment zones. Technique A consisted of a semi-automated software prototype for CT 3d rendering with the “Chebyshev Center Concept” implemented (the “Chebyshev Center” is the center of the largest inscribed sphere within the treatment zone) with automated definition of parameters for size, shape and position. Technique B consisted of standard CT 3d analysis with manual definition of the same parameters but position. Results For Protocol 1 and 2, short diameter of the treatment zone and diameter of the largest inscribed sphere within the treatment zone were not significantly different between Technique A and B. For Protocol 3, short diameter of the treatment zone and diameter of the largest inscribed sphere within the treatment zone were significantly smaller for Technique A compared with Technique B (41.1 ± 13.1 mm versus 53.8 ± 1.1 mm and 39.0 ± 8.4 mm versus 53.8 ± 1.1 mm; p < 0.05 and p < 0.01). For Protocol 1, 2 and 3, sphericity of the treatment zone was significantly larger for Technique A compared with B. Conclusions Regarding size and shape of the treatment zone after IRE, CT 3d rendering with the “Chebyshev Center Concept” implemented provides significantly different results compared with standard CT 3d analysis. Since the latter overestimates the size of the treatment zone, the “Chebyshev Center Concept” could be used for a more objective acute treatment control.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | | | | | - Christof M Sommer
- Department of Diagnostic and Interventional Radiology, University Hospital Heidelberg, Heidelberg, Germany.
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Bonekamp D, Bonekamp S, Halappa VG, Geschwind JFH, Eng J, Corona-Villalobos CP, Pawlik TM, Kamel IR. Interobserver agreement of semi-automated and manual measurements of functional MRI metrics of treatment response in hepatocellular carcinoma. Eur J Radiol 2013; 83:487-96. [PMID: 24387824 DOI: 10.1016/j.ejrad.2013.11.016] [Citation(s) in RCA: 57] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2013] [Revised: 11/11/2013] [Accepted: 11/17/2013] [Indexed: 11/28/2022]
Abstract
PURPOSE To assess the interobserver agreement in 50 patients with hepatocellular carcinoma (HCC) before and 1 month after intra-arterial therapy (IAT) using two semi-automated methods and a manual approach for the following functional, volumetric and morphologic parameters: (1) apparent diffusion coefficient (ADC), (2) arterial phase enhancement (AE), (3) portal venous phase enhancement (VE), (4) tumor volume, and assessment according to (5) the Response Evaluation Criteria in Solid Tumors (RECIST), and (6) the European Association for the Study of the Liver (EASL). MATERIALS AND METHODS This HIPAA-compliant retrospective study had institutional review board approval. The requirement for patient informed consent was waived. Tumor ADC, AE, VE, volume, RECIST, and EASL in 50 index lesions was measured by three observers. Interobserver reproducibility was evaluated using intraclass correlation coefficients (ICC). P<0.05 was considered to indicate a significant difference. RESULTS Semi-automated volumetric measurements of functional parameters (ADC, AE, and VE) before and after IAT as well as change in tumor ADC, AE, or VE had better interobserver agreement (ICC=0.830-0.974) compared with manual ROI-based axial measurements (ICC=0.157-0.799). Semi-automated measurements of tumor volume and size in the axial plane before and after IAT had better interobserver agreement (ICC=0.854-0.996) compared with manual size measurements (ICC=0.543-0.596), and interobserver agreement for change in tumor RECIST size was also higher using semi-automated measurements (ICC=0.655) compared with manual measurements (ICC=0.169). EASL measurements of tumor enhancement in the axial plane before and after IAT ((ICC=0.758-0.809), and changes in EASL after IAT (ICC=0.653) had good interobserver agreement. CONCLUSION Semi-automated measurements of functional changes assessed by ADC and VE based on whole-lesion segmentation demonstrated better reproducibility than ROI-based axial measurements, or RECIST or EASL measurements.
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Affiliation(s)
- David Bonekamp
- The Johns Hopkins School of Medicine, Department of Radiology, Baltimore, MD, United States
| | - Susanne Bonekamp
- The Johns Hopkins School of Medicine, Department of Radiology, Baltimore, MD, United States
| | - Vivek Gowdra Halappa
- The Johns Hopkins School of Medicine, Department of Radiology, Baltimore, MD, United States
| | | | - John Eng
- The Johns Hopkins School of Medicine, Department of Radiology, Baltimore, MD, United States
| | | | - Timothy M Pawlik
- The Sidney Kimmel Comprehensive Cancer Center, The Johns Hopkins University School of Medicine, Baltimore, MD, United States; The Johns Hopkins School of Medicine, Department of Surgery, Oncology, Baltimore, MD, United States
| | - Ihab R Kamel
- The Johns Hopkins School of Medicine, Department of Radiology, Baltimore, MD, United States.
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