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Amorrortu R, Garcia M, Zhao Y, El Naqa I, Balagurunathan Y, Chen DT, Thieu T, Schabath MB, Rollison DE. Overview of approaches to estimate real-world disease progression in lung cancer. JNCI Cancer Spectr 2023; 7:pkad074. [PMID: 37738580 PMCID: PMC10637832 DOI: 10.1093/jncics/pkad074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Revised: 08/28/2023] [Accepted: 09/18/2023] [Indexed: 09/24/2023] Open
Abstract
BACKGROUND Randomized clinical trials of novel treatments for solid tumors normally measure disease progression using the Response Evaluation Criteria in Solid Tumors. However, novel, scalable approaches to estimate disease progression using real-world data are needed to advance cancer outcomes research. The purpose of this narrative review is to summarize examples from the existing literature on approaches to estimate real-world disease progression and their relative strengths and limitations, using lung cancer as a case study. METHODS A narrative literature review was conducted in PubMed to identify articles that used approaches to estimate real-world disease progression in lung cancer patients. Data abstracted included data source, approach used to estimate real-world progression, and comparison to a selected gold standard (if applicable). RESULTS A total of 40 articles were identified from 2008 to 2022. Five approaches to estimate real-world disease progression were identified including manual abstraction of medical records, natural language processing of clinical notes and/or radiology reports, treatment-based algorithms, changes in tumor volume, and delta radiomics-based approaches. The accuracy of these progression approaches were assessed using different methods, including correlations between real-world endpoints and overall survival for manual abstraction (Spearman rank ρ = 0.61-0.84) and area under the curve for natural language processing approaches (area under the curve = 0.86-0.96). CONCLUSIONS Real-world disease progression has been measured in several observational studies of lung cancer. However, comparing the accuracy of methods across studies is challenging, in part, because of the lack of a gold standard and the different methods used to evaluate accuracy. Concerted efforts are needed to define a gold standard and quality metrics for real-world data.
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Affiliation(s)
| | - Melany Garcia
- Department of Cancer Epidemiology, Moffitt Cancer Center, Tampa, FL, USA
| | - Yayi Zhao
- Department of Cancer Epidemiology, Moffitt Cancer Center, Tampa, FL, USA
| | - Issam El Naqa
- Department of Machine Learning, Moffitt Cancer Center, Tampa, FL, USA
| | | | - Dung-Tsa Chen
- Department of Biostatistics and Bionformatics, Moffitt Cancer Center, Tampa, FL, USA
| | - Thanh Thieu
- Department of Machine Learning, Moffitt Cancer Center, Tampa, FL, USA
| | - Matthew B Schabath
- Department of Cancer Epidemiology, Moffitt Cancer Center, Tampa, FL, USA
| | - Dana E Rollison
- Department of Cancer Epidemiology, Moffitt Cancer Center, Tampa, FL, USA
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Hou FJ, Zhao D, Yan XY, Li XT, Sun Y, Sun YS, Gao SY. Efficacy evaluation of different measurement methods for target lesions after neoadjuvant chemotherapy and radical radiotherapy in locally advanced hypopharyngeal carcinoma. Asia Pac J Clin Oncol 2023; 19:187-195. [PMID: 35692104 DOI: 10.1111/ajco.13796] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2021] [Revised: 05/02/2022] [Accepted: 05/07/2022] [Indexed: 01/22/2023]
Abstract
AIM To assess the diagnostic efficacy in response evaluation of hypopharyngeal carcinoma (HPC) using different CT measurement methods. METHODS AND MATERIALS One hundred and three patients with locally advanced HPC receiving neoadjuvant chemotherapy (NACT) and radical radiotherapy (RT) were retrospectively enrolled. The long diameter, short diameter and largest axial area of the tumors and the largest metastatic cervical lymph node (LN) were measured before and after NACT, at the end of RT and 1 month after RT. Tumor regression ratios of the sum of the tumor's long diameter and LN's short diameter (LDTSDL), the sum of tumor and LN's short diameter (TTSDL), the sum of tumor and LN's largest axial area (AATML) were calculated. Analysis was conducted for overall survival (OS), metastasis-free survival, regional recurrence-free survival (RRFS), and local recurrence-free survival (LRFS). RESULTS Note that 35, 28, 23, and 16 patients suffered death, local recurrence, regional recurrence and distant metastasis, respectively. TTSDL-defined effective group demonstrated better LRFS (p = .039) and RRFS (p = .047) after NACT and better OS since the end of RT (p = .037); AATML-defined effective groups demonstrated better OS, LRFS, and RRFS since the end of RT (p = .015, .008, and .005). While LDTSDL-defined groups showed differences in OS and LRFS until 1 month after RT (p = .013 and .014). CONCLUSIONS The regression rate of TTSDL and AATML can distinguish prognosis at an earlier time and demonstrated better reliability compared with LDTSDL. They were recommended for response evaluation in HPC.
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Affiliation(s)
- Fang-Jing Hou
- Department of Radiology, Key laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Peking University Cancer Hospital and Institute, Peking University, Beijing, P.R. China
| | - Dan Zhao
- Department of Radiation Oncology, Key laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Peking University Cancer Hospital and Institute, Peking University, Beijing, P.R. China
| | - Xin-Yue Yan
- Department of Radiology, Key laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Peking University Cancer Hospital and Institute, Peking University, Beijing, P.R. China
| | - Xiao-Ting Li
- Department of Radiology, Key laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Peking University Cancer Hospital and Institute, Peking University, Beijing, P.R. China
| | - Yan Sun
- Department of Radiation Oncology, Key laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Peking University Cancer Hospital and Institute, Peking University, Beijing, P.R. China
| | - Ying-Shi Sun
- Department of Radiology, Key laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Peking University Cancer Hospital and Institute, Peking University, Beijing, P.R. China
| | - Shun-Yu Gao
- Department of Radiology, Key laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Peking University Cancer Hospital and Institute, Peking University, Beijing, P.R. China
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Bang TJ, Hu J, Patil T, Barón AE, Gao D, Yang JCH, Kuo HY, Huang HC, Sachs PB, Camidge DR. The Effect of Intrathoracic Lesion Location on Initial Tyrosine Kinase Inhibitor Response in Advanced Oncogene-Addicted Non-Small Cell Lung Cancer: A Comparison Between RECIST 1.1 and a Novel Method of Response Assessment (MAX). Clin Lung Cancer 2022; 23:e501-e509. [PMID: 36100512 DOI: 10.1016/j.cllc.2022.08.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2022] [Revised: 07/25/2022] [Accepted: 08/03/2022] [Indexed: 01/27/2023]
Abstract
INTRODUCTION Different subtypes of non-small cell lung cancer (NSCLC) are associated with different patterns of metastatic spread. Anatomic location of lesions in the chest may influence patterns of cancer growth and the shrinkage to therapy. Consequently, lesion location could affect apparent response rates per RECIST. We sought to explore this and develop, as needed, treatment response assessments less affected by the location. METHODS Cases of advanced oncogene-addicted NSCLC (EGFR, ALK, and ROS1) with pre- and on-therapy imaging during initial targeted therapy were identified. Lesions located in the lung parenchyma, pleural space or intra-thoracic lymph nodes were identified and analyzed separately from each other by RECIST 1.1 (unidimensional measurements) and by a novel MAX methodology (bidimensional measurements) which takes the axis with the greatest absolute percentage change on therapy in each location as the representative measurement. RESULTS Three hundred three patients with 446 unidimensional measured lesions were included for RECIST analysis. Two hundred forty nine patients with 386 bidimensional measured lesions were included for MAX analysis, as well as the analysis comparing RECIST and MAX. Intrathoracic location significantly impacted percentage shrinkage and the response rate per RECIST. The response rates for pleural, intra-parenchymal and nodal lesions were 34.1%, 49.6%, and 68.3%, respectively (P = .0002). The MAX methodology both increased the apparent treatment effect and made it consistent between intrathoracic locations. For pleural, parenchymal and nodal lesions, the MAX calculated response rate were 83.7%, 72.2%, and 75.4%, respectively (P-value = .24). CONCLUSION Intrathoracic lesion location affects RECIST-based treatment effectiveness estimations. The MAX methodology neutralizes location effect when examining impact of treatment and should be explored further.
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Affiliation(s)
- Tami J Bang
- Division of Cardiothoracic Imaging, Department of Radiology, University of Colorado, Anschutz Medical Campus, Aurora, CO
| | - Junxiao Hu
- Department of Pediatrics, University of Colorado, Anschutz Medical Campus, Aurora, CO; University of Colorado Comprehensive Cancer Center, University of Colorado Anschutz Medical Campus, Aurora, CO
| | - Tejas Patil
- Division of Medical Oncology, Department of Medicine, University of Colorado, Anschutz Medical Campus, Aurora, CO
| | - Anna E Barón
- Department of Biostatistics and Informatics, Colorado School of Public Health, University of Colorado, Anschutz Medical Campus, Aurora, CO
| | - Dexiang Gao
- Department of Pediatrics, University of Colorado, Anschutz Medical Campus, Aurora, CO; University of Colorado Comprehensive Cancer Center, University of Colorado Anschutz Medical Campus, Aurora, CO
| | - James Chih-Hsin Yang
- Department of Medical Oncology, National Taiwan University Cancer Center, Taipei, Taiwan
| | - Hung-Yang Kuo
- Department of Medical Oncology, National Taiwan University Cancer Center, Taipei, Taiwan
| | - Hsin-Chieh Huang
- Department of Radiology, National Taiwan University Hospital, Taipei, Taiwan
| | - Peter B Sachs
- Division of Cardiothoracic Imaging, Department of Radiology, University of Colorado, Anschutz Medical Campus, Aurora, CO
| | - D Ross Camidge
- Division of Medical Oncology, Department of Medicine, University of Colorado, Anschutz Medical Campus, Aurora, CO.
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Cytokine chemokine network in tumor microenvironment: Impact on CSC properties and therapeutic applications. Cytokine 2022; 156:155916. [DOI: 10.1016/j.cyto.2022.155916] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2021] [Revised: 04/27/2022] [Accepted: 05/16/2022] [Indexed: 12/21/2022]
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Unidimensional measurement may be superior to assess primary tumor response after neoadjuvant chemotherapy for nasopharyngeal carcinoma. Oncotarget 2018; 8:46937-46945. [PMID: 28159937 PMCID: PMC5564534 DOI: 10.18632/oncotarget.14941] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2016] [Accepted: 12/28/2016] [Indexed: 12/02/2022] Open
Abstract
Application of current response evaluation criteria in solid tumors (RECIST 1.1) for assessment of irregularly shaped nasopharyngeal carcinoma (NPC) is a gray area with much ambiguity. Our aim was to compare unidimensional measurements (UDM) and bidimensional measurements (BDM) on magnetic resonance images in alternative planes for measurement of tumor response after neoadjuvant chemotherapy (NACT) in patients with locally advanced NPC. 59 patients with untreated non-metastatic NPC were prospectively enrolled. The size or change in size of the primary tumor and retropharyngeal nodes was assessed by UDM and BDM on axial and coronal planes before and after 2 cycles of NACT. Tumor volume was considered as the reference standard. Correlation between volume and diameter was analyzed using a general linear model. The degree of agreement and discordance of response classification based on different measures were evaluated with κ statistic and McNemar's test, respectively. Both axial UDM (RECIST 1.1) and axial BDM (WHO) showed a significant association with volumetric standard. However, the agreement of axial UDM with VM was better than that of axial BDM (κ value: 0.514 to 0.372). In addition, when increasing coronal planes to evaluate tumor response with UDM and BDM, an inferior agreement between coronal BDM and VM was still observed. Notably, coronal UDM showed the best consistency with volume (κ = 0.585). Hence, axial UDM showed better correlation with volumetric measurements than axial BDM. Since coronal UDM showed high correlation to VM, we suggest further research to assess its use for response assessment of NPC after NACT.
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Kasangian AA, Gherardi G, Biagioli E, Torri V, Moretti A, Bernardin E, Cordovana A, Farina G, Bramati A, Piva S, Dazzani MC, Paternò E, La Verde NM. The prognostic role of tumor size in early breast cancer in the era of molecular biology. PLoS One 2017; 12:e0189127. [PMID: 29211792 PMCID: PMC5718505 DOI: 10.1371/journal.pone.0189127] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2017] [Accepted: 11/07/2017] [Indexed: 11/19/2022] Open
Abstract
Background The prognosis of early breast cancer (EBC) depends on patient and tumor characteristics. The association between tumor size, the largest diameter in TNM staging, and prognosis is well recognized. According to TNM, tumors classified as T2, could have very different volumes; e.g. a tumor of 2.1 cm has a volume of 4500 mm3, while a tumor of 4.9 cm has a volume of 60.000 mm3 even belonging to the same class. The aim of the study is to establish if the prognostic role of tumor size, expressed as diameter and volume, has been overshadowed by other factors. Methods The primary objective is to evaluate the association between tumor dimensions and overall survival (OS) / disease free survival (DFS), in our institution from January 1st 2005 to September 30th 2013 in a surgical T1-T2 population. Volume was evaluated with the measurement of three half-diameters of the tumor (a, b and c), and calculated using the following formula: 4/3π x a x b x c. Results 341 patients with T1-T2 EBC were included. 86.5% were treated with conservative surgery. 85.1% had a Luminal subtype, 9.1% were Triple negative and 7.4% were HER2 positive. Median volume was 942 mm3 (range 0.52–31.651.2). 44 patients (12.9%) relapsed and 23 patients died. With a median follow-up of 6.5 years, the univariate analysis for DFS showed an association between age, tumor size, volume, histological grading and molecular subtype. The multivariate analysis confirmed the statistically significant association only for molecular subtype (p 0.005), with a worse prognosis for Triple negative and HER2 positive subtypes compared with Luminal (HR: 2.65; 95%CI: 1.34–5.22). Likewise for OS, an association was shown by the multivariate analysis solely for molecular subtype (HER2 and Triple negative vs. Luminal. HR: 2.83; 95% CI:1.46–5.49; p 0.002). Conclusions In our study, the only parameter that strongly influences survival is molecular subtype. These findings encourage clinicians to choose adjuvant treatment not based on dimensional criteria but on biological features.
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Affiliation(s)
- Anaid Anna Kasangian
- ASST Fatebenefratelli Sacco PO Fatebenefratelli Breast Surgery Unit, Milan, Italy
| | - Giorgio Gherardi
- ASST Fatebenefratelli Sacco PO Fatebenefratelli Department of Pathology, Milan, Italy
| | - Elena Biagioli
- IRCCS—Mario Negri Institute for Pharmacological Research, Milan, Laboratory of Methodology for Biomedical Research, Milan, Italy
| | - Valter Torri
- IRCCS—Mario Negri Institute for Pharmacological Research, Milan, Laboratory of Methodology for Biomedical Research, Milan, Italy
| | - Anna Moretti
- ASST Fatebenefratelli Sacco PO Fatebenefratelli Department of Oncology, Milan, Italy
- * E-mail:
| | - Elena Bernardin
- ASST Fatebenefratelli Sacco PO Fatebenefratelli Breast Surgery Unit, Milan, Italy
| | - Andrea Cordovana
- ASST Fatebenefratelli Sacco PO Fatebenefratelli Breast Surgery Unit, Milan, Italy
| | - Gabriella Farina
- ASST Fatebenefratelli Sacco PO Fatebenefratelli Department of Oncology, Milan, Italy
| | - Annalisa Bramati
- ASST Fatebenefratelli Sacco PO Fatebenefratelli Department of Oncology, Milan, Italy
| | - Sheila Piva
- ASST Fatebenefratelli Sacco PO Fatebenefratelli Department of Oncology, Milan, Italy
| | - Maria Chiara Dazzani
- ASST Fatebenefratelli Sacco PO Fatebenefratelli Department of Oncology, Milan, Italy
| | - Emanuela Paternò
- ASST Fatebenefratelli Sacco PO Fatebenefratelli Department of Oncology, Milan, Italy
| | - Nicla Maria La Verde
- ASST Fatebenefratelli Sacco PO Fatebenefratelli Department of Oncology, Milan, Italy
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Lux CN, Culp WTN, Johnson LR, Kent M, Mayhew P, Daniaux LA, Carr A, Puchalski S. PROSPECTIVE COMPARISON OF TUMOR STAGING USING COMPUTED TOMOGRAPHY VERSUS MAGNETIC RESONANCE IMAGING FINDINGS IN DOGS WITH NASAL NEOPLASIA: A PILOT STUDY. Vet Radiol Ultrasound 2017; 58:315-325. [PMID: 28233364 DOI: 10.1111/vru.12486] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2016] [Accepted: 12/23/2016] [Indexed: 11/29/2022] Open
Abstract
Identification of nasal neoplasia extension and tumor staging in dogs is most commonly performed using computed tomography (CT), however magnetic resonance imaging (MRI) is routinely used in human medicine. A prospective pilot study enrolling six dogs with nasal neoplasia was performed with CT and MRI studies acquired under the same anesthetic episode. Interobserver comparison and comparison between the two imaging modalities with regard to bidimensional measurements of the nasal tumors, tumor staging using historical schemes, and assignment of an ordinal scale of tumor margin clarity at the tumor-soft tissue interface were performed. The hypotheses included that MRI would have greater tumor measurements, result in higher tumor staging, and more clearly define the tumor soft tissue interface when compared to CT. Evaluation of bone involvement of the nasal cavity and head showed a high level of agreement between CT and MRI. Estimation of tumor volume using bidimensional measurements was higher on MRI imaging in 5/6 dogs, and resulted in a median tumor volume which was 18.4% higher than CT imaging. Disagreement between CT and MRI was noted with meningeal enhancement, in which two dogs were positive for meningeal enhancement on MRI and negative on CT. One of six dogs had a higher tumor stage on MRI compared to CT, while the remaining five agreed. Magnetic resonance imaging resulted in larger bidimensional measurements and tumor volume estimates, along with a higher likelihood of identifying meningeal enhancement when compared to CT imaging. Magnetic resonance imaging may provide integral information for tumor staging, prognosis, and treatment planning.
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Affiliation(s)
- Cassie N Lux
- Department of Surgical and Radiological Sciences, School of Veterinary Medicine, University of California-Davis, Davis, CA, 95616.,Department of Small Animal Clinical Sciences, College of Veterinary Medicine, University of Tennessee, 2407 River Dr, Knoxville, TN, 37996
| | - William T N Culp
- Department of Surgical and Radiological Sciences, School of Veterinary Medicine, University of California-Davis, Davis, CA, 95616
| | - Lynelle R Johnson
- Department of Medicine and Epidemiology, School of Veterinary Medicine, University of California-Davis, Davis, CA, 95616
| | - Michael Kent
- Department of Medicine and Epidemiology, School of Veterinary Medicine, University of California-Davis, Davis, CA, 95616
| | - Philipp Mayhew
- Department of Medicine and Epidemiology, School of Veterinary Medicine, University of California-Davis, Davis, CA, 95616
| | - Lise A Daniaux
- Department of Medicine and Epidemiology, School of Veterinary Medicine, University of California-Davis, Davis, CA, 95616.,Antech Imaging Services, Flumet, France, 73590
| | - Alaina Carr
- Department of Medicine and Epidemiology, School of Veterinary Medicine, University of California-Davis, Davis, CA, 95616.,Seattle Veterinary Specialists, Kirkland, WA, 98034
| | - Sarah Puchalski
- Department of Medicine and Epidemiology, School of Veterinary Medicine, University of California-Davis, Davis, CA, 95616.,Circle Oak Equine Sports Medicine and Rehabilitation, Petaluma, CA, 94954
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Kanemura S, Kuribayashi K, Funaguchi N, Shibata E, Mikami K, Doi H, Kitajima K, Hasegawa S, Nakano T. Metabolic response assessment with 18F-FDG-PET/CT is superior to modified RECIST for the evaluation of response to platinum-based doublet chemotherapy in malignant pleural mesothelioma. Eur J Radiol 2016; 86:92-98. [PMID: 28027772 DOI: 10.1016/j.ejrad.2016.11.009] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2016] [Accepted: 11/04/2016] [Indexed: 12/23/2022]
Abstract
PURPOSE Efficient monitoring of tumor responsiveness to chemotherapy is essential to mitigate high mortality risks and cytotoxic effects of chemotherapeutics. However, there is no consensus on the most suitable diagnostic technique/parameters for assessing response to chemotherapy in malignant pleural mesothelioma (MPM). We compared the tumor responsiveness of MPM patients as assessed using modified RECIST (mRECIST) criteria and integrated 18F-FDG-PET/CT. METHODS Histologically confirmed MPM patients (N=82) who were treated with three cycles of cisplatin and pemetrexed, or carboplatin and pemetrexed, were included. mRECIST and integrated 18F-FDG-PET/CT were used to evaluate MPM tumor response to chemotherapy. Metabolic non-responders were defined as those with a 25% or greater increase in SUVmax compared with the previous value. Time to progression (TTP) and overall survival (OS) were compared between metabolic-responders and non-responders. RESULTS After three cycles of chemotherapy, 62(75.6%) of the patients were classified as having SD, 15 (18%) with partial remission (PR), and 5 (6%) with progressive disease (PD), based on mRECIST criteria. The cumulative median OS was 728.0days (95% confidence interval [CI]: 545.9-910.1) and cumulative median TTP was 365.0days (95% CI: 296.9-433.1). For the 82 patients, the disease control rate was 93.9%, whereas the metabolic response rate was only 71.9% (p<0.001). All PD and PR patients were found to be metabolic responders on 18F-FDG-PET/CT; however, among the 62mRECIST SD patients, 18 (29%) were classified as metabolic non-responders. The median TTP for metabolic responders was 13.7 months, while it was 10.0 months for non-responders(p<0.001). Metabolic responders had a trend toward longer OS, although the difference did not reach statistical significance (metabolic responders:33.9 months; non-responders: 21.6 months; p>0.05). CONCLUSION Several mRECIST-confirmed SD MPM patients may be classified as metabolic non-responders on18F-FDGPET/CT. Metabolic response is significantly correlated with the median TTP, suggesting it should be included in the evaluation of the response to chemotherapy in MPM patients classified as mRECIST SD, to identify non-responders.
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Affiliation(s)
- Shingo Kanemura
- Department of Respiratory Medicine, Hyogo College of Medicine, 1-1 Mukogawa-cho, Nishinomiya, Hyogo 663-8501, Japan
| | - Kozo Kuribayashi
- Department of Respiratory Medicine, Hyogo College of Medicine, 1-1 Mukogawa-cho, Nishinomiya, Hyogo 663-8501, Japan.
| | - Norihiko Funaguchi
- Department of Respiratory Medicine, Murakami Memorial Hospital, Asahi University, 3-23 Hashimoto-cho, Gifu 500-8523, Japan
| | - Eisuke Shibata
- Department of Respiratory Medicine, Hyogo College of Medicine, 1-1 Mukogawa-cho, Nishinomiya, Hyogo 663-8501, Japan
| | - Koji Mikami
- Department of Respiratory Medicine, Hyogo College of Medicine, 1-1 Mukogawa-cho, Nishinomiya, Hyogo 663-8501, Japan
| | - Hiroshi Doi
- Department of Radiology, Hyogo College of Medicine, 1-1 Mukogawa-cho, Nishinomiya, Hyogo 663-8501, Japan
| | - Kazuhiro Kitajima
- Division of Nuclear Medicine and PET center, Department of Radiology, Hyogo College of Medicine, 1-1 Mukogawa-cho, Nishinomiya, Hyogo 663-8501, Japan
| | - Seiki Hasegawa
- Department of Thoracic Surgery, Hyogo College of Medicine, 1-1 Mukogawa-cho, Nishinomiya, Hyogo 663-8501, Japan
| | - Takashi Nakano
- Department of Respiratory Medicine, Hyogo College of Medicine, 1-1 Mukogawa-cho, Nishinomiya, Hyogo 663-8501, Japan
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Pinelli V, Roca E, Lucchini S, Laroumagne S, Loundou A, Dutau H, Maldonado F, Astoul P. Positron Emission Tomography/Computed Tomography for the Pleural Staging of Malignant Pleural Mesothelioma: How Accurate Is It? Respiration 2015; 89:558-64. [DOI: 10.1159/000381922] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2014] [Accepted: 03/26/2015] [Indexed: 11/19/2022] Open
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Cojoc M, Peitzsch C, Kurth I, Trautmann F, Kunz-Schughart LA, Telegeev GD, Stakhovsky EA, Walker JR, Simin K, Lyle S, Fuessel S, Erdmann K, Wirth MP, Krause M, Baumann M, Dubrovska A. Aldehyde Dehydrogenase Is Regulated by β-Catenin/TCF and Promotes Radioresistance in Prostate Cancer Progenitor Cells. Cancer Res 2015; 75:1482-94. [PMID: 25670168 DOI: 10.1158/0008-5472.can-14-1924] [Citation(s) in RCA: 177] [Impact Index Per Article: 19.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2014] [Accepted: 12/31/2014] [Indexed: 11/16/2022]
Abstract
Radiotherapy is a curative treatment option in prostate cancer. Nevertheless, patients with high-risk prostate cancer are prone to relapse. Identification of the predictive biomarkers and molecular mechanisms of radioresistance bears promise to improve cancer therapies. In this study, we show that aldehyde dehydrogenase (ALDH) activity is indicative of radioresistant prostate progenitor cells with an enhanced DNA repair capacity and activation of epithelial-mesenchymal transition (EMT). Gene expression profiling of prostate cancer cells, their radioresistant derivatives, ALDH(+) and ALDH(-) cell populations revealed the mechanisms, which link tumor progenitors to radioresistance, including activation of the WNT/β-catenin signaling pathway. We found that expression of the ALDH1A1 gene is regulated by the WNT signaling pathway and co-occurs with expression of β-catenin in prostate tumor specimens. Inhibition of the WNT pathway led to a decrease in ALDH(+) tumor progenitor population and to radiosensitization of cancer cells. Taken together, our results indicate that ALDH(+) cells contribute to tumor radioresistance and their molecular targeting may enhance the effectiveness of radiotherapy.
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Affiliation(s)
- Monica Cojoc
- OncoRay-National Center for Radiation Research in Oncology, Medical Faculty and University Hospital Carl Gustav Carus, Technische Universität Dresden and Helmholtz-Zentrum Dresden-Rossendorf, Fetscherstrasse, Dresden, Germany
| | - Claudia Peitzsch
- OncoRay-National Center for Radiation Research in Oncology, Medical Faculty and University Hospital Carl Gustav Carus, Technische Universität Dresden and Helmholtz-Zentrum Dresden-Rossendorf, Fetscherstrasse, Dresden, Germany.
| | - Ina Kurth
- OncoRay-National Center for Radiation Research in Oncology, Medical Faculty and University Hospital Carl Gustav Carus, Technische Universität Dresden and Helmholtz-Zentrum Dresden-Rossendorf, Fetscherstrasse, Dresden, Germany
| | - Franziska Trautmann
- OncoRay-National Center for Radiation Research in Oncology, Medical Faculty and University Hospital Carl Gustav Carus, Technische Universität Dresden and Helmholtz-Zentrum Dresden-Rossendorf, Fetscherstrasse, Dresden, Germany
| | - Leoni A Kunz-Schughart
- OncoRay-National Center for Radiation Research in Oncology, Medical Faculty and University Hospital Carl Gustav Carus, Technische Universität Dresden and Helmholtz-Zentrum Dresden-Rossendorf, Fetscherstrasse, Dresden, Germany
| | - Gennady D Telegeev
- Institute of Molecular Biology and Genetics NAS of Ukraine, Kyiv, Ukraine
| | | | - John R Walker
- Genomics Institute of the Novartis Research Foundation, San Diego, California
| | - Karl Simin
- UMass Cancer Center Tissue Bank, Department of Cancer Biology, UMass Medical School, Worcester, Massachusetts
| | - Stephen Lyle
- UMass Cancer Center Tissue Bank, Department of Cancer Biology, UMass Medical School, Worcester, Massachusetts
| | - Susanne Fuessel
- Department of Urology, Medical Faculty and University Hospital Carl Gustav Carus, Technische Universität Dresden, Fetscherstrasse, Dresden, Germany
| | - Kati Erdmann
- Department of Urology, Medical Faculty and University Hospital Carl Gustav Carus, Technische Universität Dresden, Fetscherstrasse, Dresden, Germany
| | - Manfred P Wirth
- Department of Urology, Medical Faculty and University Hospital Carl Gustav Carus, Technische Universität Dresden, Fetscherstrasse, Dresden, Germany
| | - Mechthild Krause
- OncoRay-National Center for Radiation Research in Oncology, Medical Faculty and University Hospital Carl Gustav Carus, Technische Universität Dresden and Helmholtz-Zentrum Dresden-Rossendorf, Fetscherstrasse, Dresden, Germany. Department of Radiation Oncology, Medical Faculty and University Hospital Carl Gustav Carus, Technische Universität Dresden, Fetscherstrasse, Dresden, Germany. Institute of Radiation Oncology, Helmholtz-Zentrum Dresden-Rossendorf, Germany, Bautzner Landstrasse, Dresden, Germany. German Cancer Consortium (DKTK) Dresden and German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Michael Baumann
- OncoRay-National Center for Radiation Research in Oncology, Medical Faculty and University Hospital Carl Gustav Carus, Technische Universität Dresden and Helmholtz-Zentrum Dresden-Rossendorf, Fetscherstrasse, Dresden, Germany. Department of Radiation Oncology, Medical Faculty and University Hospital Carl Gustav Carus, Technische Universität Dresden, Fetscherstrasse, Dresden, Germany. Institute of Radiation Oncology, Helmholtz-Zentrum Dresden-Rossendorf, Germany, Bautzner Landstrasse, Dresden, Germany. German Cancer Consortium (DKTK) Dresden and German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Anna Dubrovska
- OncoRay-National Center for Radiation Research in Oncology, Medical Faculty and University Hospital Carl Gustav Carus, Technische Universität Dresden and Helmholtz-Zentrum Dresden-Rossendorf, Fetscherstrasse, Dresden, Germany. German Cancer Consortium (DKTK) Dresden and German Cancer Research Center (DKFZ), Heidelberg, Germany.
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11
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Mäbert K, Cojoc M, Peitzsch C, Kurth I, Souchelnytskyi S, Dubrovska A. Cancer biomarker discovery: current status and future perspectives. Int J Radiat Biol 2014; 90:659-77. [PMID: 24524284 DOI: 10.3109/09553002.2014.892229] [Citation(s) in RCA: 79] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
PURPOSE Cancer is a multigene disease which arises as a result of mutational and epigenetic changes coupled with activation of complex signaling networks. The use of biomarkers for early cancer detection, staging and individualization of therapy might improve patient care. A few fundamental issues such as tumor heterogeneity, a highly dynamic nature of the intrinsic and extrinsic determinants of radio- and chemoresistance, along with the plasticity and diversity of cancer stem cells (CSC) make biomarker development a challenging task. In this review we outline the preclinical strategies of cancer biomarker discovery including genomic, proteomic, metabolomic and microRNomic profiling, comparative genome hybridization (CGH), single nucleotide polymorphism (SNP) analysis, high throughput screening (HTS) and next generation sequencing (NGS). Other promising approaches such as assessment of circulating tumor cells (CTC), analysis of CSC-specific markers and cell-free circulating tumor DNA (ctDNA) are also discussed. CONCLUSIONS The emergence of powerful proteomic and genomic technologies in conjunction with advanced bioinformatic tools allows the simultaneous analysis of thousands of biological molecules. These techniques yield the discovery of new tumor signatures, which are sensitive and specific enough for early cancer detection, for monitoring disease progression and for proper treatment selection, paving the way to individualized cancer treatment.
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Affiliation(s)
- Katrin Mäbert
- OncoRay-National Center for Radiation Research in Oncology, Medical Faculty Dresden Carl Gustav Carus , TU Dresden , Germany
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12
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Lima JPDSN, de Souza FH, de Andrade DAP, Carvalheira JBC, dos Santos LV. Independent radiologic review in metastatic colorectal cancer: systematic review and meta-analysis. Radiology 2012; 263:86-95. [PMID: 22438443 DOI: 10.1148/radiol.11111111] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
PURPOSE To perform a meta-analysis addressing evaluation bias in local radiologic assessment (LRA) of lesions when compared with independent radiologic review (IRR) in randomized controlled trials (RCTs) testing chemotherapy for metastatic colorectal cancer (CRC). MATERIALS AND METHODS MEDLINE, EMBASE, ClinicalTrials.gov, the Cochrane Library, and Web sites for major medical meetings were searched for RCTs of chemotherapy for metastatic CRC that reported response evaluation by both LRA and IRR. The risk ratios (RRs) of response in the experimental (RR(exp)) and control (RR(cont)) arms were calculated (response rate in LRA divided by response rate in IRR) for each selected study. The ratio of RR of response was calculated (RR of response of LRA divided by RR of response of IRR). The random-effects model was applied. Meta-regression was used to examine the effect of study characteristics on outcomes. RESULTS LRA and IRR results were concordant (13 studies; 7742 patients; ratio of RR of response = 0.97; 95% confidence interval [95% CI]: 0.90, 1.04; P = .35). However, LRA overestimated tumor response independently of therapy allocation (interaction test, P = .81) both in control (RR(cont), 1.163; 95% CI: 1.086, 1.246; P < .001) and experimental (RR(exp), 1.156; 95% CI: 1.093, 1.222; P < .001) therapies. Meta-regression did not show any effect of trial characteristics on effects. CONCLUSION LRA yields higher response rates in RCTs testing chemotherapy for metastatic CRC, although there was no sign of bias toward experimental therapy. The need for IRR to control evaluation bias must be reappraised.
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Nowak AK, Francis RJ, Katz SI, Gerbaudo VH. A Multimodality Imaging Review of Malignant Pleural Mesothelioma Response Assessment. PET Clin 2011; 6:299-311. [PMID: 27156725 DOI: 10.1016/j.cpet.2011.04.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Assessment of response is important to interpret early phase clinical trial results and to guide individual patient management. In malignant pleural mesothelioma (MPM), the circumferential growth pattern of the disease, the presence of pleural effusion and atelectasis, and the common use of pleurodesis make this a challenging task for imaging specialists and clinicians. This article reviews the current evidence for radiological and positron emission tomography (PET) response assessment in MPM, and the pitfalls and challenges in its application. Current research and future directions in radiological and PET response are discussed, including the use of novel radiotracers.
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Affiliation(s)
- Anna K Nowak
- School of Medicine and Pharmacology, University of Western Australia, 35 Stirling Highway, Nedlands, Perth 6009, Western Australia, Australia; Department of Medical Oncology, Sir Charles Gairdner Hospital, Verdun Street, Nedlands, Perth 6009, Western Australia, Australia
| | - Roslyn J Francis
- School of Medicine and Pharmacology, University of Western Australia, 35 Stirling Highway, Nedlands, Perth 6009, Western Australia, Australia; Department of Medical Oncology, Sir Charles Gairdner Hospital, Verdun Street, Nedlands, Perth 6009, Western Australia, Australia
| | - Sharyn I Katz
- Department of Radiology, Hospital of the University of Pennsylvania, University of Pennsylvania School of Medicine, 1 Silverstein Building, 3400 Spruce Street, Philadelphia, PA 19104, USA
| | - Victor H Gerbaudo
- Division of Nuclear Medicine and Molecular Imaging, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA 02115, USA
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Korkaya H, Liu S, Wicha MS. Regulation of cancer stem cells by cytokine networks: attacking cancer's inflammatory roots. Clin Cancer Res 2011; 17:6125-9. [PMID: 21685479 DOI: 10.1158/1078-0432.ccr-10-2743] [Citation(s) in RCA: 251] [Impact Index Per Article: 19.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
There is substantial evidence that many human cancers are driven by a subpopulation of cells that display stem cell properties. These cancer stem cells (CSC) may also contribute to metastasis and treatment resistance. Furthermore, just as normal stem cells are regulated by their microenvironment, or niche, CSCs interact with and in turn are regulated by cells in the tumor microenvironment. These interactions involve inflammatory cytokines, such as interleukin (IL)-1, IL-6, and IL-8, which in turn activate Stat3/NF-κB pathways in both tumor and stromal cells. Activation of these pathways stimulates further cytokine production, generating positive feedback loops that in turn drive CSC self-renewal. These cytokine loops and the pathways they regulate resemble those activated during chronic inflammation and wound healing, and may contribute to the known link between inflammation and cancer. Inhibitors of these cytokines and their receptors have been developed as anti-inflammatory agents. By blocking signals from the tumor microenvironment, these agents have the potential to target CSCs. Future clinical trials using these compounds will be needed to determine whether targeting the CSC population has clinical benefit.
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Affiliation(s)
- Hasan Korkaya
- Comprehensive Cancer Center, University of Michigan, Ann Arbor, Michigan 48109, USA
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15
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Creaney J, Francis RJ, Dick IM, Musk AW, Robinson BWS, Byrne MJ, Nowak AK. Serum soluble mesothelin concentrations in malignant pleural mesothelioma: relationship to tumor volume, clinical stage and changes in tumor burden. Clin Cancer Res 2010; 17:1181-9. [PMID: 21177406 DOI: 10.1158/1078-0432.ccr-10-1929] [Citation(s) in RCA: 88] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
PURPOSE To examine the clinical utility of soluble mesothelin in patients with malignant pleural mesothelioma. EXPERIMENTAL DESIGN A total of 97 patients (female: 11; male: 86) were prospectively enrolled, longitudinal serum samples collected, and mesothelin concentrations determined. Baseline mesothelin levels were analyzed relative to tumor stage, presence of metastatic disease, the positron emission tomography (PET) parameters maximum standardized uptake value, tumor volume, total glycolytic volume, and survival. Changes in mesothelin level were correlated to objective response to chemotherapy, as assessed radiologically and by PET imaging, and with patient survival. RESULTS Baseline mesothelin levels greater than 5 nmol/L were a significant negative prognostic indicator (HR = 2.25; 95% CI, 1.20-4.21) and correlated with tumor stage and volume. In 55 patients who received chemotherapy, change in mesothelin correlated with radiological response (χ(2) = 11.32; P = 0.023) and change in metabolically active tumor volume (r = 0.58; P < 0.01). Median survival for patients with a reduction in mesothelin following chemotherapy (19 months) was significantly longer than for patients with increased mesothelin (5 months; P < 0.001). CONCLUSION These findings show the potential value of changes in mesothelin levels for prognostication and monitoring of treatment response in mesothelioma.
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Affiliation(s)
- Jenette Creaney
- National Research Centre for Asbestos Related Diseases, School of Medicine and Pharmacology, University of Western Australia, Sir Charles Gairdner Hospital, Nedlands, Western Australia, Australia.
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Assessment of therapy responses and prediction of survival in malignant pleural mesothelioma through computer-aided volumetric measurement on computed tomography scans. J Thorac Oncol 2010; 5:879-84. [PMID: 20421814 DOI: 10.1097/jto.0b013e3181dd0ef1] [Citation(s) in RCA: 70] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE The purposes of this study were (1) to calculate the tumor volume in patients with malignant pleural mesothelioma using computed tomography (CT) scan images and a computer-aided measurement technique and (2) to investigate whether the baseline volume, or volume change after chemotherapy, predicts patient survival. METHODS We compiled the clinical characteristics and outcome from 30 patients enrolled in two clinical trials at our cancer center in which the patients were treated with induction chemotherapy followed by surgery and radiation. CT scans of 30 patients were obtained at baseline and after two cycles of chemotherapy. Tumor volumes were calculated using a semiautomated computer algorithm. Overall survival was measured using a landmark time at 3 months post-treatment start date such that all patients had already received two cycles of chemotherapy and a follow-up scan. Association of volume changes with overall survival were determined by a Cox Proportional Hazards Model or log-rank test. The relationship between both pre and postoperative clinical stage and baseline tumor volume was analyzed using the rank sum test. RESULTS The median baseline tumor volume was 473 cm(3) (range, 61 cm(3)-2108 cm(3)). Patients with high preoperative stages (III and IV) had larger baseline tumor volume than those with low preoperative stages (I and II) (p = 0.05). Patients with baseline volumes smaller than 619 cm(3) tended to survive longer than those with baseline volumes larger than or equal to 619 cm(3) (p = 0.07). Percentage change of tumor volume from baseline to first follow-up CT after two cycles of chemotherapy was significantly associated with overall survival (hazard ratio: 1.94 [95% confidence interval, 1.05-3.60], p = 0.04). Whereas the relative change in modified RECIST measurements was not significantly associated with overall survival (hazard ratio: 1.06 [95% confidence interval, 0.96-1.16], p = 0.25). By classifying changes of tumor volumes between two scans into two groups, i.e., "increase" and "decrease," a significant difference in survival was found between those who increased and decreased after two cycles of chemotherapy (p = 0.03). CONCLUSIONS Changes in tumor volume after two cycles of chemotherapy predicted overall survival in patients with malignant pleural mesothelioma. Tumor volume at baseline was shown to be associated with preoperative clinical stage and survival. Computer-aided volumetric measurements may enable more reliable therapeutic response assessment and could provide additional prognostic information.
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Lee HY, Hyun SH, Lee KS, Kim BT, Kim J, Shim YM, Ahn MJ, Kim TS, Yi CA, Chung MJ. Volume-Based Parameter of 18F-FDG PET/CT in Malignant Pleural Mesothelioma: Prediction of Therapeutic Response and Prognostic Implications. Ann Surg Oncol 2010; 17:2787-94. [DOI: 10.1245/s10434-010-1107-z] [Citation(s) in RCA: 136] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2010] [Indexed: 12/22/2022]
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18
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Three-dimensional evaluation of chemotherapy response in malignant pleural mesothelioma. Eur J Radiol 2010; 74:130-5. [DOI: 10.1016/j.ejrad.2009.02.002] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2008] [Revised: 01/26/2009] [Accepted: 02/05/2009] [Indexed: 11/30/2022]
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19
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Lee CC, Ho HC, Su YC, Lee MS, Hsiao SH, Hwang JH, Hung SK, Chou P, Lee CC. Bidimensional measurement of nasopharyngeal carcinoma: a simple method to predict outcomes. Clin Otolaryngol 2009; 34:26-33. [DOI: 10.1111/j.1749-4486.2008.01839.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Sørensen JB, Frank H, Palshof T. Cisplatin and vinorelbine first-line chemotherapy in non-resectable malignant pleural mesothelioma. Br J Cancer 2008; 99:44-50. [PMID: 18542078 PMCID: PMC2453034 DOI: 10.1038/sj.bjc.6604421] [Citation(s) in RCA: 46] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2007] [Revised: 04/21/2008] [Accepted: 04/24/2008] [Indexed: 12/29/2022] Open
Abstract
The aim was to evaluate the activity of cisplatin and vinorelbine in previously untreated, inoperable patients having histologically verified malignant pleural mesothelioma (MPM), normal organ function, and performance status 0-2. Treatment was vinorelbine 25 mg m(-2) i.v. weekly and cisplatin 100 mg m(-2) i.v. every 4 weeks with hydration and standard prophylactic antiemetic treatment. Patients gave written informed consent. Characteristics of 54 consecutive patients were: males 85%, epithelial subtype 74%, IMIG stages III and IV 35 and 46%, performance status 0, 1, and 2, 26, 69, and 6%, and median age 63 years (31-78 years). CTC grade 3 or 4 toxicity occurred with respect to leukocytopenia (48% of patients, grade 4 in 13%), nausea (13%), neurotoxicity (11%), nephrotoxicity (4%), and other toxicities (9%). There were no toxic deaths. The median number of cycles was four. The fraction of patients alive at 1-, 2-, and 3-years were 61, 31, and 4%, respectively, and median survival and median time to progression were 16.8 months (0.5 to 46.4 +months) and 7.2 months (1.6 to 40.6 + months). There were two CRs and 14 PRs (response rate 29.6%). Cisplatin and intravenous vinorelbine is a highly active regimen in MPM with a response rate and survival comparable to the most active regimens so far reported.
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Affiliation(s)
- J B Sørensen
- Department Oncology, Finsen Centre/National University Hospital, 9 Blegdamsvej, Copenhagen DK-2100, Denmark.
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21
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Nakano T. Current therapies for malignant pleural mesothelioma. Environ Health Prev Med 2008; 13:75-83. [PMID: 19568885 DOI: 10.1007/s12199-007-0016-7] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2007] [Accepted: 09/26/2007] [Indexed: 12/29/2022] Open
Abstract
Mesothelioma is a highly lethal tumor derived from mesothelial cells, and its global incidence is increasing because of widespread exposure of numerous individuals to asbestos in the last 50 years. Mesothelioma is largely untreatable with any of the therapeutic modalities. Recently, a novel multitargeted antifolate pemetrexed has shown promising activity against malignant pleural mesothelioma, producing response rates of up to 40% when used in combination with cisplatin. In a large phase III study, use of a combination of pemetrexed and cisplatin was associated with significantly improved survival time and with greater antitumor activity compared with cisplatin alone. This combination also gave a significant response rate of approximately 50% in patients with epithelioid malignant pleural mesothelioma. These clinical benefits of pemetrexed-cisplatin doublet have changed the perception of mesothelioma chemotherapy. Other combinations, including gemcitabine in combination with cisplatin, have also shown encouraging response rates. Prognosis depends on gender, clinical stage of the tumor, histological subtype, platelet count, leukocyte counts, and performance status. Radiotherapy can palliate mesothelioma patients with chest pain, and has been indicated to be of benefit for the prevention of malignant seeding along the tract of a chest tube or needle biopsy. Trimodality treatment using extrapleural pneumonectomy, radiation and chemotherapy has shown promising therapeutic value. The development of chemotherapeutic regimens and the favorable outcomes of trimodality have led to new combined modality trials. In Japan, multicenter national trials against mesothelioma will begin in the near future.
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Affiliation(s)
- Takashi Nakano
- Division of Respiratory Medicine, Department of Internal Medicine, Hyogo College of Medicine, 1-1 Mukogawa-cho, Nishinomiya, Hyogo, Japan.
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Sørensen JB. Current concepts in chemotherapy for malignant pleural mesothelioma. CLINICAL RESPIRATORY JOURNAL 2008; 2:74-9. [DOI: 10.1111/j.1752-699x.2008.00046.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Armato SG, Entwisle J, Truong MT, Nowak AK, Ceresoli GL, Zhao B, Misri R, Kindler HL. Current state and future directions of pleural mesothelioma imaging. Lung Cancer 2007; 59:411-20. [PMID: 18061303 DOI: 10.1016/j.lungcan.2007.09.027] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2007] [Revised: 09/20/2007] [Accepted: 09/29/2007] [Indexed: 11/20/2022]
Abstract
The diagnosis, staging, and response assessment of mesothelioma pose unique challenges to radiologic imaging. No single, conventional imaging approach captures the information necessary to direct all aspects of patient management. Instead, the complexities of this unique disease demand the integration of elements cleverly adapted from different modalities. Imaging-based studies presented at the 8th International Conference of the International Mesothelioma Interest Group (IMIG) in October 2006 sought to further define the current practice and future potential of radiology for the mesothelioma patient. The imaging studies selected through a peer-review process for presentation at the 2006 IMIG Conference were intended to frame this research in the context of the unique imaging challenges presented by mesothelioma while stimulating dialogue on the future resolution of these challenges. This communication conveys the pitfalls and potential of pleural mesothelioma imaging based on work presented at the Conference. From diagnosis to response, PET/CT to molecular bioprobes, volumetric analysis to computerized tumor assessment, imaging promises to provide valuable insight for patients with mesothelioma and the physicians who treat them.
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Affiliation(s)
- Samuel G Armato
- Department of Radiology, The University of Chicago, 5841 S. Maryland Ave., MC 2026, Chicago, IL 60637, USA.
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Ceresoli GL, Chiti A, Zucali PA, Cappuzzo F, De Vincenzo F, Cavina R, Rodari M, Poretti D, Lutman FR, Santoro A. Assessment of tumor response in malignant pleural mesothelioma. Cancer Treat Rev 2007; 33:533-41. [PMID: 17764849 DOI: 10.1016/j.ctrv.2007.07.012] [Citation(s) in RCA: 46] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2007] [Revised: 07/17/2007] [Accepted: 07/25/2007] [Indexed: 11/18/2022]
Abstract
Most patients with malignant pleural mesothelioma (MPM) are candidates for chemotherapy during the course of their disease. Assessment of the response with conventional criteria based on computed tomography (CT) measurements is challenging, due to the circumferential and axial pattern of growth of MPM. Such difficulties hinder an accurate evaluation of clinical study results and make the clinical management of patients critical. Several radiological response systems have been proposed, but neither WHO criteria nor the more recent RECIST unidimensional criteria nor hybrid uni- and bidimensional criteria seem to apply to tumor measurement in this disease. Recently, modified RECIST criteria for MPM have been published. Although they are already being used in current clinical trials, they have been criticized based on the high grade of inter-observer variability and on theoretical studies of mesothelioma growth according to non-spherical models. Computer-assisted techniques for CT measurement are being developed. The use of FDG-PET for prediction of response and, more importantly, of survival outcomes of MPM patients is promising and warrants validation in large prospective series. New serum markers such as osteopontin and mesothelin-related proteins are under evaluation and in the future might play a role in assessing the response of MPM to treatment.
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Affiliation(s)
- Giovanni L Ceresoli
- Department of Medical Oncology and Hematology, Istituto Clinico Humanitas IRCCS, Rozzano, Milan, Italy.
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Ozden H, Ak G, Metintas S, Metintas M, Sahin B, Erginel S, Civi K. Relationship between tumorsize of malignant pleural mesothelioma and its response to chemotherapy. ACTA ACUST UNITED AC 2007. [DOI: 10.1248/jhs.53.23] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Affiliation(s)
- Hilmi Ozden
- Department of Anatomy, Eskisehir Osmangazi University Medical School
| | - Güntülü Ak
- Department of Chest Disease, Eskisehir Osmangazi University Medical School
| | - Selma Metintas
- Department of Public Health, Eskisehir Osmangazi University Medical School
| | - Muzaffer Metintas
- Department of Chest Disease, Eskisehir Osmangazi University Medical School
| | - Bünyamin Sahin
- Department of Anatomy, Ondokuz Mayis University Medical School
| | - Sinan Erginel
- Department of Chest Disease, Eskisehir Osmangazi University Medical School
| | - Kismet Civi
- Department of Pathology, Dumlupinar University, Education and Training Haspital
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Lee SM, Ko SY, Seo TH, Lee JH, Choi SO, Lee JG, Kim WS, Lee TH, Yoo GH, Lee KY. Dramatic Tumor Response to 2nd-line Pemetrexed/Cisplatin Combination Chemotherapy in Patient with Malignant Pleural Mesothelioma. Tuberc Respir Dis (Seoul) 2007. [DOI: 10.4046/trd.2007.62.5.432] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Affiliation(s)
- Seung Min Lee
- Department of Internal Medicine, College of Medicine, Konkuk University, Seoul, Korea
| | - Soon Young Ko
- Department of Internal Medicine, College of Medicine, Konkuk University, Seoul, Korea
| | - Tae Ho Seo
- Department of Internal Medicine, College of Medicine, Konkuk University, Seoul, Korea
| | - Jung Hyun Lee
- Department of Internal Medicine, College of Medicine, Konkuk University, Seoul, Korea
| | - Seung Oh Choi
- Department of Internal Medicine, College of Medicine, Konkuk University, Seoul, Korea
| | - Jeong Geun Lee
- Department of Radiology, College of Medicine, Konkuk University, Seoul, Korea
| | - Wan Seop Kim
- Department of Pathology, College of Medicine, Konkuk University, Seoul, Korea
| | - Tae Hoon Lee
- Department of Internal Medicine, College of Medicine, Konkuk University, Seoul, Korea
| | - Gwang Ha Yoo
- Department of Internal Medicine, College of Medicine, Konkuk University, Seoul, Korea
| | - Kye Young Lee
- Department of Internal Medicine, College of Medicine, Konkuk University, Seoul, Korea
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27
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Ceresoli GL, Chiti A, Zucali PA, Rodari M, Lutman RF, Salamina S, Incarbone M, Alloisio M, Santoro A. Early Response Evaluation in Malignant Pleural Mesothelioma by Positron Emission Tomography With [18F]Fluorodeoxyglucose. J Clin Oncol 2006; 24:4587-93. [PMID: 17008700 DOI: 10.1200/jco.2006.06.8999] [Citation(s) in RCA: 132] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Purpose Response evaluation with conventional criteria based on computed tomography (CT) is particularly challenging in malignant pleural mesothelioma (MPM) due to its diffuse pattern of growth. There is growing evidence that therapy-induced changes in tumor [18F]fluorodeoxyglucose (FDG) uptake as measured by positron emission tomography (PET) may predict response and patient outcome early in the course of treatment. Patients and Methods Patients with histologically proven MPM, not candidates to curative surgery, scheduled to undergo palliative chemotherapy with a pemetrexed-based regimen were eligible for this study. Patients were evaluated by FDG-PET and CT at baseline and after two cycles of therapy. A decrease of 25% or more in tumor FDG uptake as measured by standardized uptake value was defined as a metabolic response (MR). Best overall response from CT scans was determined according to previously published criteria. Results Twenty-two patients were included in the study, and 20 were assessable for early metabolic response with FDG-PET. Of these, eight were classified as responders (40%) and 12 as nonresponders (60%). Early MR was significantly correlated to median time-to-tumor progression (TTP) with a median TTP for metabolic responders of 14 months versus 7 months for nonresponders (P = .02). No correlation was found between TTP and radiologic response evaluated by CT. Patients with a MR had a trend toward longer overall survival. Conclusion The use of MR evaluated by FDG-PET in the assessment of treatment efficacy in MPM appears promising. Our observations need to be validated in a larger prospective series.
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Affiliation(s)
- Giovanni L Ceresoli
- Department of Medical Oncology and Hematology, Istituto Clinico Humanitas IRCCS, Rozzano, Milan, Italy.
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Abstract
RECIST (Response Evaluation Criteria in Solid Tumors) is a widely employed method introduced in 2000 to assess change in tumor size in response to therapy. The simplicity of the technique, however, contrasts sharply with the increasing sophistication of imaging instrumentation. Anatomically based imaging measurement, although supportive of drug development and key to some accelerated drug approvals, is being pressed to improve its methodologic robustness, particularly in the light of more functionally-based imaging that is sensitive to tissue molecular response such as fluorodeoxyglucose positron emission tomography. Nevertheless ready availability of computed tomography and magnetic resonance imaging machines largely assures anatomically based imaging a continuing role in clinical trials for the foreseeable future. Recent advances in image processing enabled by the computational power of modern clinical scanners open a considerable opportunity to characterize tumor response to therapy as a complement to image acquisition. Various alternative quantitative volumetric approaches have been proposed but have yet to gain wide acceptance by clinical and regulatory communities, nor have these more complex techniques shown incontrovertible evidence of greater reproducibility or predictive value of clinical events and outcome. Unless plans are created for clinical trials that incorporate the design needed to prove the added value and unique clinical utility of these novel approaches, any theoretical benefit of these more elaborate methods could remain unfulfilled.
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Affiliation(s)
- C Carl Jaffe
- Diagnostic Imaging Branch, Cancer Imaging Program, Division of Cancer Treatment and Diagnosis, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA.
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Francart J, Legrand C, Sylvester R, Van Glabbeke M, van Meerbeeck JP, Robert A. Progression-Free Survival Rate As Primary End Point for Phase II Cancer Clinical Trials: Application to Mesothelioma—The EORTC Lung Cancer Group. J Clin Oncol 2006; 24:3007-12. [PMID: 16809726 DOI: 10.1200/jco.2005.05.1359] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Purpose Phase II cancer clinical trials play a key role in the development of new drugs. These trials should be designed to accurately determine if the drug should be abandoned or if it is sufficiently promising for further investigation in phase III trials. With new cytostatic agents or when the response assessment is difficult, using the progression-free survival rate (PFSR) at a fixed time point, such as 3, 4, 5, or 6 months, instead of the response rate (RR) as the primary end point is an alternative approach. To design future phase II trials, reference values for PFSRs that correspond to drugs with insufficient (P0) and sufficient (P1) clinical activity (CA) are necessary. This article provides these values in mesothelioma. Materials and Methods The European Organisation for Research and Treatment of Cancer database registered ten closed mesothelioma trials (nine phase II trials and one phase III trial) with 523 total patients. Trials were grouped into three categories according to the published RR: significant (n = 259), moderate (n = 142), and insufficient (n = 122) CA. Results The PFSRs at 3, 4, 5, and 6 months, respectively, were as follows: 72%, 67%, 51%, and 43% in the group with significant CA; 59%, 51%, 42%, and 35% with moderate CA; and 52%, 40%, 34%, and 28% with insufficient CA. Conclusion These values may be used to define relevant P0 and P1 values in future phase II mesothelioma trials that use PFSR as the primary end point.
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Affiliation(s)
- Julie Francart
- European Organisation for Research and Treatment of Cancer.
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Therasse P, Eisenhauer EA, Verweij J. RECIST revisited: a review of validation studies on tumour assessment. Eur J Cancer 2006; 42:1031-9. [PMID: 16616487 DOI: 10.1016/j.ejca.2006.01.026] [Citation(s) in RCA: 326] [Impact Index Per Article: 18.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2006] [Accepted: 01/24/2006] [Indexed: 12/16/2022]
Abstract
The response evaluation criteria in solid tumours (RECIST) was developed in the late 1990s to replace the WHO criteria for response evaluation. The new criteria included important changes such as unidimensional tumour measurement, selection of target lesions with a minimum size, details concerning imaging modalities and a new threshold for assignment of objective progression. RECIST was published in February 2000 and very quickly came into operation first in clinical trials performed under the auspices of EORTC, US NCI or NCI Canada Clinical Trials Group but was adopted quickly thereafter by the entire cancer clinical research community. As several key features of RECIST were based on analysis of retrospective clinical data, it was felt important to carefully monitor the implementation of the guidelines and stimulate prospective validation studies. This paper reviews the literature that has been published on RECIST from 2000 up to November 2005. In total 60 papers and ASCO, abstracts directly refer to research studies or reviews related to RECIST and its implementation. Amongst the 60 references identified for this review, 11 papers refer to validation studies (seven prospective and four retrospective), six papers refer to the comparison of unidimensional measurements versus bi or tri-dimensional measurements, 12 papers address issues raised with the implementation of RECIST in Mesothelioma and Gastro-Intestinal Stromal Tumours and four papers report on an adaptation of RECIST for specific tumour types. In general, RECIST has been well received by the scientific community and most validation studies fully support the implementation of the new criteria. As expected, however, some issues have been identified. In keeping with the mathematical differences in definition of progression, RECIST delays the identification of progression as compared to WHO criteria in some instances. RECIST criteria are not easily applicable in some types of trials such as those in paediatric tumours and in mesothelioma. Furthermore, anatomical changes in the tumour as described by RECIST may be detected later than functional changes in some circumstances, as for example in Gastro-Intestinal Stromal Tumours treated with Imatinib. However, there is no other universal method of tumour assessment as yet and functional imaging methods have not been validated and will not be widely available for some time. The findings of this review, together with experience acquired thus far and the results of some ongoing research projects, have paved the way for RECIST 2.0 to be hopefully announced later this year.
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Affiliation(s)
- P Therasse
- EORTC Data center, Avenue E. Mounier, 83 Box 11, 1200 Brussels, Belgium.
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Galanis E, Buckner JC, Maurer MJ, Sykora R, Castillo R, Ballman KV, Erickson BJ. Validation of neuroradiologic response assessment in gliomas: measurement by RECIST, two-dimensional, computer-assisted tumor area, and computer-assisted tumor volume methods. Neuro Oncol 2006; 8:156-65. [PMID: 16533757 PMCID: PMC1871930 DOI: 10.1215/15228517-2005-005] [Citation(s) in RCA: 100] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
Significant limitations are associated with the use of standard radiographic measurements as indicators of response in glioma therapy trials. The Response Evaluation Criteria in Solid Tumors (RECIST) were recently introduced in an attempt to standardize and simplify assessment of response to treatment in cancer clinical trials. However, their applicability in gliomas has been assessed in only a very small number of patients. Our aim was to validate radiographic response assessment in newly diagnosed glioma patients. Sixty-seven newly diagnosed glioma patients participating in nine North Central Cancer Treatment Group glioma trials were included; 565 MRI scans were analyzed. All scans were performed with the same technique. Kappa statistics were calculated to determine agreement between assessment methods. Cox proportional hazards analyses and time-dependent Cox models were used to assess the association between different measurement methods and overall survival. Results showed agreement between the one-dimensional (1D) and two-dimensional (2D) measurements both for T2 images and for gadolinium-enhanced images. Comparison of duration of response and time to progression as assessed by eight different methods showed similarity in response assessments by 1D, 2D, area, and volume gadolinium measurements. In contrast, time to progression was significantly shorter when assessed by 1D-T2 or 2D-T2 images as compared to area-T2 or volume-T2 images. This set of data indicates that RECIST could be used instead of 2D imaging for response assessment in newly diagnosed glioma trials. Overall, responses as determined by any tumor measurement method did not correlate with patient survival for either enhancing or nonenhancing tumors, although the small number of responders limits definitive conclusions. Time-dependent Cox models demonstrated that, in contrast to the case of nonenhancing tumors, progression as determined by 1D, 2D, area, and volume measurements in gadolinium-enhanced images was predictive of survival of patients with enhancing tumors.
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Affiliation(s)
- Evanthia Galanis
- Division of Medical oncology, Mayo clinic, rochester, MN 55905, USA.
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Abstract
The radiologic evaluation of disease, which now includes the quantification of disease, has become an essential part of clinical medicine. The unique circumferential and often scalloped morphology of mesothelioma, however, distinguishes it from other thoracic neoplasms. The challenges of measuring mesothelioma are many. In this article, the authors explore the demands, the current standard of clinical practice, and the opportunities associated with the radiologic measurement of mesothelioma.
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Affiliation(s)
- Samuel G Armato
- Department of Radiology, University of Chicago, 5841 South Maryland Avenue, MC 2026, Chicago, IL 60637, USA.
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Benamore RE, O'Doherty MJ, Entwisle JJ. Use of imaging in the management of malignant pleural mesothelioma. Clin Radiol 2005; 60:1237-47. [PMID: 16291305 DOI: 10.1016/j.crad.2005.05.015] [Citation(s) in RCA: 54] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2005] [Revised: 05/23/2005] [Accepted: 05/25/2005] [Indexed: 11/19/2022]
Abstract
Malignant pleural mesothelioma (MPM) is an increasingly prevalent tumour. The death rate associated with MPM is predicted to peak in the next 10 years, although radiologists and clinicians will be encountering cases for the next few decades. Contrast-enhanced CT is an established technique for evaluating suspected malignant pleural disease, but MPM can be reliably diagnosed only by histological sampling. However, even with adequate sampling and the use of immunocytochemistry, histological diagnosis is known to be difficult; definitive diagnosis may involve a combination of clinical presentation, radiological and histological appearances. Percutaneous biopsy is a promising technique for sampling the pleura. In view of its pattern of growth, MPM is a challenging disease to image by any method, and it behaves quite differently from lung cancer. This review aims to highlight the practical aspects of assessing malignant pleural mesothelioma.
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Affiliation(s)
- R E Benamore
- Department of Radiology, University Hospitals of Leicester, UK
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Nowak AK. Phase II trials in mesothelioma: An increasing challenge. Lung Cancer 2005; 50:87-90. [PMID: 16026892 DOI: 10.1016/j.lungcan.2005.05.024] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2005] [Accepted: 05/26/2005] [Indexed: 10/25/2022]
Affiliation(s)
- Anna K Nowak
- Department of Medicine and Pharmacology, University of Western Australia, Hospital Avenue, Nedlands, WA 6009, Australia
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Ishii H, Furuse J, Nakachi K, Suzuki EI, Yoshino M. Primary tumor of pancreatic cancer as a measurable target lesion in chemotherapy trials. Jpn J Clin Oncol 2005; 35:601-6. [PMID: 16172174 DOI: 10.1093/jjco/hyi151] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND It is unclear whether primary pancreatic cancer (PC) tumors can be accepted as measurable target lesions in chemotherapy trials. We reviewed recent PC patients to clarify the significance of their computed tomography (CT) responses of the primary tumor after chemotherapy. METHODS The patient selection criteria were (i) having been admitted between January 2002 and December 2004, (ii) diagnosed as having histologically or cytologically proven adenocarcinoma of the pancreas, (iii) treated with chemotherapy with no previous anticancer treatment and (iv) having been evaluated by follow-up CT to assess the response according to the Response Evaluation Criteria in Solid Tumors criteria. RESULTS A total of 143 patients met the selection criteria. It was possible to measure the largest diameter of the primary tumor in 119 (83%) of the 143, and primary tumor shrinkage was observed in 10 (8%) of the 119. When regarding the primary as measurable as opposed to non-measurable, the number of patients with measurable disease became 127 from 67, and the frequencies of partial response (PR), stable disease (SD) and progressive disease (PD) became 11, 74 and 15% of the 127 from 18, 52 and 30% of the 67, respectively. In the former situation, large primary tumor sometimes canceled the shrinkage or progression of small metastasis. In each setting, PR or SD represented a favorable prognosis compared with PD, however, there were no statistical differences between the PR and the SD. CONCLUSION Measuring the primary tumor is acceptable in approximately 80% of PC patients. However, we must be aware that the frequency of SD may increase compared with the PR or PD.
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Affiliation(s)
- Hiroshi Ishii
- Department of Hepatobiliary and Pancreatic Medical Oncology, National Cancer Center Hospital East, Kashiwa, Chiba 277-8577, Japan.
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Abstract
Malignant pleural mesothelioma (MPM) is a seemingly uncommon tumor whose incidence has in fact increased steadily and progressively over the last 30 years. Indeed, an actual "epidemic" is expected in Europe over the next 20 years. Despite unquestionable improvement in the diagnostic methods at our disposal and the availability of new treatment strategies, the prognosis of MPM patients remains dramatically poor (12 to 18 months' median survival from diagnosis), although exceptional cases of long-survivors are reported in all literature series. The current review will cover the dramatic improvements in the treatment of this rare disease that have been recently achieved, as well as the promise that new, molecular-targeted therapies, such as bortezomid, mTOR ( m ammalian t arget o f r apamycin) inhibitors, and Met inhibitors, seem to offer for the next few years. With pemetrexed we now have a drug that is able to impact patient survival. Together with the newer drugs, rapidly emerging from the laboratory to be applied in the clinic, we have the hope of making further advances in the struggle against this disease.
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Abstract
Malignant pleural mesothelioma has a very specific growth pattern invading the pleural surfaces and neighboring structures. For this reason precise estimation of tumor volume and description of local extension are particularly difficult. Different staging systems have been introduced, and the most widely used are discussed. Restaging of mesothelioma after induction therapy is even more complicated and still controversial. The recently described, modified response evaluation criteria in solid tumors (RECIST) criteria are presently the most accurate for response evaluation.
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Affiliation(s)
- P Van Schil
- Department of Thoracic and Vascular Surgery, University Hospital of Antwerp, Wilrijkstraat 10, B-2650 Edegem, Antwerp, Belgium.
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Abstract
CONTEXT The incidence of malignant pleural mesothelioma is increasing throughout most of the world. This cancer is uniformly fatal, and characterised by progressive breathlessness and unremitting pain in the chest wall. From the onset of symptoms, survival is from a few weeks to a few years. Desperation by patients and doctors has driven a search for effective treatments. Clinical benefits are marginal and evidence of a good quality is lamentably lacking. STARTING POINT David Sugarbaker is the world's leading proponent of extrapleural pneumonectomy (EPP), an operation in which all the pleura is removed with the lung, pericardium, and diaphragm. He has recently reported the complications of this radical surgery in a series of 496 operations (J Thorac Cardiovasc Surg 2004; 128: 138-46). Although EPP as part of trimodality therapy (preoperative chemotherapy and postoperative radiation) is thought to be the best that can be offered and is regarded as the standard of care for selected patients given the morbidity associated with it, evidence for benefit is needed to justify its wider use. WHERE NEXT? With the increase in the number of cases there is increasing awareness of the disease, leading to earlier diagnosis, and an expectation that something must be done. Survival is short and the treatments on offer are onerous. The only responsible approach from a scientific, compassionate, or economic view (and why not combine all three?) is to find evidence of effectiveness to avoid futile and distressing treatment when possible.
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Affiliation(s)
- Tom Treasure
- Cardiothoracic Unit, Guy's Hospital, London SE1 9RT, UK.
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Affiliation(s)
- Gunnar Hillerdal
- Department of Lung Medicine, Karolinska Hospital, Stockholm, Sweden
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