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Iannessi A, Beaumont H, Ojango C, Bertrand AS, Liu Y. RECIST 1.1 assessments variability: a systematic pictorial review of blinded double reads. Insights Imaging 2024; 15:199. [PMID: 39112819 PMCID: PMC11306910 DOI: 10.1186/s13244-024-01774-w] [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: 03/28/2024] [Accepted: 07/07/2024] [Indexed: 08/10/2024] Open
Abstract
Reader variability is intrinsic to radiologic oncology assessments, necessitating measures to enhance consistency and accuracy. RECIST 1.1 criteria play a crucial role in mitigating this variability by standardizing evaluations, aiming to establish an accepted "truth" confirmed by histology or patient survival. Clinical trials utilize Blind Independent Centralized Review (BICR) techniques to manage variability, employing double reads and adjudicators to address inter-observer discordance effectively. It is essential to dissect the root causes of variability in response assessments, with a specific focus on the factors influencing RECIST evaluations. We propose proactive measures for radiologists to address variability sources such as radiologist expertise, image quality, and accessibility of contextual information, which significantly impact interpretation and assessment precision. Adherence to standardization and RECIST guidelines is pivotal in diminishing variability and ensuring uniform results across studies. Variability factors, including lesion selection, new lesion appearance, and confirmation bias, can have profound implications on assessment accuracy and interpretation, underscoring the importance of identifying and addressing these factors. Delving into the causes of variability aids in enhancing the accuracy and consistency of response assessments in oncology, underscoring the role of standardized evaluation protocols and mitigating risk factors that contribute to variability. Access to contextual information is crucial. CRITICAL RELEVANCE STATEMENT: By understanding the causes of diagnosis variability, we can enhance the accuracy and consistency of response assessments in oncology, ultimately improving patient care and clinical outcomes. KEY POINTS: Baseline lesion selection and detection of new lesions play a major role in the occurrence of discordance. Image interpretation is influenced by contextual information, the lack of which can lead to diagnostic uncertainty. Radiologists must be trained in RECIST criteria to reduce errors and variability.
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Affiliation(s)
- Antoine Iannessi
- Cancer Center Antoine Lacassagne 33 Av. de Valombrose, 06100, Nice, France
- Median Technologies SA 1800 Route des Crêtes, 06560, Valbonne, France
| | - Hubert Beaumont
- Median Technologies SA 1800 Route des Crêtes, 06560, Valbonne, France.
| | - Christine Ojango
- Median Technologies SA 1800 Route des Crêtes, 06560, Valbonne, France
| | - Anne-Sophie Bertrand
- Imaging Center Beaulieu-sur-mer 18 Bd Eugène Gauthier, 06310, Beaulieu-sur-Mer, France
| | - Yan Liu
- Median Technologies SA 1800 Route des Crêtes, 06560, Valbonne, France
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Yeghaian M, Tareco Bucho TM, de Bruin M, Schmitz A, Bodalal Z, Smit EF, Beets-Tan RGH, van den Broek D, Trebeschi S. Can blood-based markers predict RECIST progression in non-small cell lung cancer treated with immunotherapy? J Cancer Res Clin Oncol 2024; 150:329. [PMID: 38922374 PMCID: PMC11208229 DOI: 10.1007/s00432-024-05814-2] [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: 12/01/2023] [Accepted: 05/21/2024] [Indexed: 06/27/2024]
Abstract
PURPOSE In this study, we aimed to evaluate the potential of routine blood markers, serum tumour markers and their combination in predicting RECIST-defined progression in patients with stage IV non-small cell lung cancer (NSCLC) undergoing treatment with immune checkpoint inhibitors. METHODS We employed time-varying statistical models and machine learning classifiers in a Monte Carlo cross-validation approach to investigate the association between RECIST-defined progression and blood markers, serum tumour markers and their combination, in a retrospective cohort of 164 patients with NSCLC. RESULTS The performance of the routine blood markers in the prediction of progression free survival was moderate. Serum tumour markers and their combination with routine blood markers generally improved performance compared to routine blood markers alone. Elevated levels of C-reactive protein (CRP) and alkaline phosphatase (ALP) ranked as the top predictive routine blood markers, and CYFRA 21.1 was consistently among the most predictive serum tumour markers. Using these classifiers to predict overall survival yielded moderate to high performance, even when cases of death-defined progression were excluded. Performance varied across the treatment journey. CONCLUSION Routine blood tests, especially when combined with serum tumour markers, show moderate predictive value of RECIST-defined progression in NSCLC patients receiving immune checkpoint inhibitors. The relationship between overall survival and RECIST-defined progression may be influenced by confounding factors.
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Affiliation(s)
- Melda Yeghaian
- GROW Research Institute for Oncology and Reproduction, Maastricht University, Maastricht, The Netherlands
- Radiology Department, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Teresa M Tareco Bucho
- GROW Research Institute for Oncology and Reproduction, Maastricht University, Maastricht, The Netherlands
- Radiology Department, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Melissa de Bruin
- Radiology Department, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Alexander Schmitz
- Radiology Department, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Zuhir Bodalal
- GROW Research Institute for Oncology and Reproduction, Maastricht University, Maastricht, The Netherlands
- Radiology Department, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Egbert F Smit
- Pulmonology Department, Leiden University Medical Center, Leiden, The Netherlands
| | - Regina G H Beets-Tan
- GROW Research Institute for Oncology and Reproduction, Maastricht University, Maastricht, The Netherlands
- Radiology Department, Netherlands Cancer Institute, Amsterdam, The Netherlands
- Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark
| | - Daan van den Broek
- Department of Laboratory Medicine, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Stefano Trebeschi
- GROW Research Institute for Oncology and Reproduction, Maastricht University, Maastricht, The Netherlands.
- Radiology Department, Netherlands Cancer Institute, Amsterdam, The Netherlands.
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3
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Pelc Z, Sędłak K, Leśniewska M, Mielniczek K, Chawrylak K, Skórzewska M, Ciszewski T, Czechowska J, Kiszczyńska A, Wijnhoven BPL, Van Sandick JW, Gockel I, Gisbertz SS, Piessen G, Eveno C, Bencivenga M, De Manzoni G, Baiocchi GL, Morgagni P, Rosati R, Fumagalli Romario U, Davies A, Endo Y, Pawlik TM, Roviello F, Bruns C, Polkowski WP, Rawicz-Pruszyński K. Textbook Neoadjuvant Outcome-Novel Composite Measure of Oncological Outcomes among Gastric Cancer Patients Undergoing Multimodal Treatment. Cancers (Basel) 2024; 16:1721. [PMID: 38730672 PMCID: PMC11083243 DOI: 10.3390/cancers16091721] [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: 04/11/2024] [Revised: 04/26/2024] [Accepted: 04/26/2024] [Indexed: 05/13/2024] Open
Abstract
The incidence of gastric cancer (GC) is expected to increase to 1.77 million cases by 2040. To improve treatment outcomes, GC patients are increasingly treated with neoadjuvant chemotherapy (NAC) prior to curative-intent resection. Although NAC enhances locoregional control and comprehensive patient care, survival rates remain poor, and further investigations should establish outcomes assessment of current clinical pathways. Individually assessed parameters have served as benchmarks for treatment quality in the past decades. The Outcome4Medicine Consensus Conference underscores the inadequacy of isolated metrics, leading to increased recognition and adoption of composite measures. One of the most simple and comprehensive is the "All or None" method, which refers to an approach where a specific set of criteria must be fulfilled for an individual to achieve the overall measure. This narrative review aims to present the rationale for the implementation of a novel composite measure, Textbook Neoadjuvant Outcome (TNO). TNO integrates five objective and well-established components: Treatment Toxicity, Laboratory Tests, Imaging, Time to Surgery, and Nutrition. It represents a desired, multidisciplinary care and hospitalization of GC patients undergoing NAC to identify the treatment- and patient-related data required to establish high-quality oncological care further. A key strength of this narrative review is the clinical feasibility and research background supporting the implementation of the first and novel composite measure representing the "ideal" and holistic care among patients with locally advanced esophago-gastric junction (EGJ) and GC in the preoperative period after NAC. Further analysis will correlate clinical outcomes with the prognostic factors evaluated within the TNO framework.
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Affiliation(s)
- Zuzanna Pelc
- Department of Surgical Oncology, Medical University of Lublin, 20079 Lublin, Poland; (Z.P.); (K.S.); (M.L.); (K.M.); (K.C.); (M.S.); (T.C.); (J.C.); (A.K.); (W.P.P.)
| | - Katarzyna Sędłak
- Department of Surgical Oncology, Medical University of Lublin, 20079 Lublin, Poland; (Z.P.); (K.S.); (M.L.); (K.M.); (K.C.); (M.S.); (T.C.); (J.C.); (A.K.); (W.P.P.)
| | - Magdalena Leśniewska
- Department of Surgical Oncology, Medical University of Lublin, 20079 Lublin, Poland; (Z.P.); (K.S.); (M.L.); (K.M.); (K.C.); (M.S.); (T.C.); (J.C.); (A.K.); (W.P.P.)
| | - Katarzyna Mielniczek
- Department of Surgical Oncology, Medical University of Lublin, 20079 Lublin, Poland; (Z.P.); (K.S.); (M.L.); (K.M.); (K.C.); (M.S.); (T.C.); (J.C.); (A.K.); (W.P.P.)
| | - Katarzyna Chawrylak
- Department of Surgical Oncology, Medical University of Lublin, 20079 Lublin, Poland; (Z.P.); (K.S.); (M.L.); (K.M.); (K.C.); (M.S.); (T.C.); (J.C.); (A.K.); (W.P.P.)
| | - Magdalena Skórzewska
- Department of Surgical Oncology, Medical University of Lublin, 20079 Lublin, Poland; (Z.P.); (K.S.); (M.L.); (K.M.); (K.C.); (M.S.); (T.C.); (J.C.); (A.K.); (W.P.P.)
| | - Tomasz Ciszewski
- Department of Surgical Oncology, Medical University of Lublin, 20079 Lublin, Poland; (Z.P.); (K.S.); (M.L.); (K.M.); (K.C.); (M.S.); (T.C.); (J.C.); (A.K.); (W.P.P.)
| | - Joanna Czechowska
- Department of Surgical Oncology, Medical University of Lublin, 20079 Lublin, Poland; (Z.P.); (K.S.); (M.L.); (K.M.); (K.C.); (M.S.); (T.C.); (J.C.); (A.K.); (W.P.P.)
| | - Agata Kiszczyńska
- Department of Surgical Oncology, Medical University of Lublin, 20079 Lublin, Poland; (Z.P.); (K.S.); (M.L.); (K.M.); (K.C.); (M.S.); (T.C.); (J.C.); (A.K.); (W.P.P.)
| | - Bas P. L. Wijnhoven
- Department of General Surgery, Erasmus Medical Center, 3015 GD Rotterdam, The Netherlands;
| | - Johanna W. Van Sandick
- Department of Surgical Oncology, The Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital, 1066 CX Amsterdam, The Netherlands;
| | - Ines Gockel
- Department of Visceral, Transplant, Thoracic and Vascular Surgery, University Hospital Leipzig, 04103 Leipzig, Germany;
| | - Suzanne S. Gisbertz
- Department of Surgery, Amsterdam UMC location University of Amsterdam, 1007 MB Amsterdam, The Netherlands;
- Cancer Treatment and Quality of Life, Cancer Center Amsterdam, 1081 HV Amsterdam, The Netherlands
| | - Guillaume Piessen
- Department of Digestive and Oncological Surgery, University Lille, and Claude Huriez University Hospital, 59000 Lille, France; (G.P.); (C.E.)
| | - Clarisse Eveno
- Department of Digestive and Oncological Surgery, University Lille, and Claude Huriez University Hospital, 59000 Lille, France; (G.P.); (C.E.)
| | - Maria Bencivenga
- Upper G.I. Surgery Division, University of Verona, 37126 Verona, Italy; (M.B.); (G.D.M.)
| | - Giovanni De Manzoni
- Upper G.I. Surgery Division, University of Verona, 37126 Verona, Italy; (M.B.); (G.D.M.)
| | - Gian Luca Baiocchi
- Department of Clinical and Experimental Sciences, Surgical Clinic, University of Brescia, and Third Division of General Surgery, Spedali Civili di Brescia, 25123 Brescia, Italy;
| | - Paolo Morgagni
- Department of General Surgery, Morgagni-Pierantoni Hospital, 47121 Forlì, Italy;
| | - Riccardo Rosati
- Department of Gastrointestinal Surgery, IRCCS San Raffaele Hospital, Vita Salute University, 20132 Milan, Italy;
| | | | - Andrew Davies
- Department of Upper Gastrointestinal and General Surgery, Guy’s and St Thomas’ Hospital, London SE1 7EH, UK;
| | - Yutaka Endo
- Department of Surgery, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, Columbus, OH 43210, USA; (Y.E.); (T.M.P.)
| | - Timothy M. Pawlik
- Department of Surgery, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, Columbus, OH 43210, USA; (Y.E.); (T.M.P.)
| | - Franco Roviello
- Department of Medicine, Surgery, and Neurosciences, University of Siena, 53100 Siena, Italy;
| | - Christiane Bruns
- Department of General, Visceral, Cancer and Transplantation Surgery, University Hospital of Cologne, 50937 Cologne, Germany;
| | - Wojciech P. Polkowski
- Department of Surgical Oncology, Medical University of Lublin, 20079 Lublin, Poland; (Z.P.); (K.S.); (M.L.); (K.M.); (K.C.); (M.S.); (T.C.); (J.C.); (A.K.); (W.P.P.)
| | - Karol Rawicz-Pruszyński
- Department of Surgical Oncology, Medical University of Lublin, 20079 Lublin, Poland; (Z.P.); (K.S.); (M.L.); (K.M.); (K.C.); (M.S.); (T.C.); (J.C.); (A.K.); (W.P.P.)
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Cappello G, Romano V, Neri E, Fournier L, D'Anastasi M, Laghi A, Zamboni GA, Beets-Tan RGH, Schlemmer HP, Regge D. A European Society of Oncologic Imaging (ESOI) survey on the radiological assessment of response to oncologic treatments in clinical practice. Insights Imaging 2023; 14:220. [PMID: 38117394 PMCID: PMC10733253 DOI: 10.1186/s13244-023-01568-6] [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: 07/16/2023] [Accepted: 11/08/2023] [Indexed: 12/21/2023] Open
Abstract
OBJECTIVES To present the results of a survey on the assessment of treatment response with imaging in oncologic patient, in routine clinical practice. The survey was promoted by the European Society of Oncologic Imaging to gather information for the development of reporting models and recommendations. METHODS The survey was launched on the European Society of Oncologic Imaging website and was available for 3 weeks. It consisted of 5 sections, including 24 questions related to the following topics: demographic and professional information, methods for lesion measurement, how to deal with diminutive lesions, how to report baseline and follow-up examinations, which previous studies should be used for comparison, and role of RECIST 1.1 criteria in the daily clinical practice. RESULTS A total of 286 responses were received. Most responders followed the RECIST 1.1 recommendations for the measurement of target lesions and lymph nodes and for the assessment of tumor response. To assess response, 48.6% used previous and/or best response study in addition to baseline, 25.2% included the evaluation of all main time points, and 35% used as the reference only the previous study. A considerable number of responders used RECIST 1.1 criteria in daily clinical practice (41.6%) or thought that they should be always applied (60.8%). CONCLUSION Since standardized criteria are mainly a prerogative of clinical trials, in daily routine, reporting strategies are left to radiologists and oncologists, which may issue local and diversified recommendations. The survey emphasizes the need for more generally applicable rules for response assessment in clinical practice. CRITICAL RELEVANCE STATEMENT Compared to clinical trials which use specific criteria to evaluate response to oncological treatments, the free narrative report usually adopted in daily clinical practice may lack clarity and useful information, and therefore, more structured approaches are needed. KEY POINTS · Most radiologists consider standardized reporting strategies essential for an objective assessment of tumor response in clinical practice. · Radiologists increasingly rely on RECIST 1.1 in their daily clinical practice. · Treatment response evaluation should require a complete analysis of all imaging time points and not only of the last.
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Affiliation(s)
- Giovanni Cappello
- Radiology Unit, Candiolo Cancer Institute, FPO-IRCCS, Str. Prov.le 142 km 3.95, 10060, Candiolo (Turin), Italy.
| | - Vittorio Romano
- Radiology Unit, Candiolo Cancer Institute, FPO-IRCCS, Str. Prov.le 142 km 3.95, 10060, Candiolo (Turin), Italy
- Department of Surgical Sciences, University of Turin, Turin, Italy
| | - Emanuele Neri
- Department of Translational Research, Academic Radiology, University of Pisa, 56124, Pisa, Italy
| | - Laure Fournier
- Radiology Department, Hôpital Européen Georges Pompidou, AP-HP, Université de Paris, 20 Rue Leblanc, 75015, Paris, France
| | - Melvin D'Anastasi
- Medical Imaging Department, Mater Dei Hospital, University of Malta, Msida, 2090, MSD, Malta
| | - Andrea Laghi
- Department of Medical Surgical Sciences and Translational Medicine, Sapienza University of Rome, Sant'Andrea University Hospital, Via Di Grottarossa, 1035-1039, 00189, Rome, Italy
| | - Giulia A Zamboni
- Department of Diagnostics and Public Health, Institute of Radiology, University of Verona, Policlinico GB Rossi, P.Le LA Scuro 10, 37134, Verona, Italy
| | - Regina G H Beets-Tan
- Department of Radiology, The Netherlands Cancer Institute, P.O. Box 90203, 1006 BE, Amsterdam, The Netherlands
- GROW School for Oncology and Developmental Biology, University of Maastricht, Maastricht, The Netherlands
| | - Heinz-Peter Schlemmer
- Department of Radiology, German Cancer Research Center (DKFZ), Im Neuenheimer Feld 280, 69120, Heidelberg, Germany
| | - Daniele Regge
- Radiology Unit, Candiolo Cancer Institute, FPO-IRCCS, Str. Prov.le 142 km 3.95, 10060, Candiolo (Turin), Italy
- Academic Radiology, Department of Translational Research on New Technologies in Medicine and Surgery, University of Pisa, Via Roma 67, Pisa, 56126, Italy
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5
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Murphy PS, Galette P, van der Aart J, Janiczek RL, Patel N, Brown AP. The role of clinical imaging in oncology drug development: progress and new challenges. Br J Radiol 2023; 96:20211126. [PMID: 37393537 PMCID: PMC10546429 DOI: 10.1259/bjr.20211126] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2021] [Revised: 02/14/2023] [Accepted: 06/06/2023] [Indexed: 07/03/2023] Open
Abstract
In 2008, the role of clinical imaging in oncology drug development was reviewed. The review outlined where imaging was being applied and considered the diverse demands across the phases of drug development. A limited set of imaging techniques was being used, largely based on structural measures of disease evaluated using established response criteria such as response evaluation criteria in solid tumours. Beyond structure, functional tissue imaging such as dynamic contrast-enhanced MRI and metabolic measures using [18F]flourodeoxyglucose positron emission tomography were being increasingly incorporated. Specific challenges related to the implementation of imaging were outlined including standardisation of scanning across study centres and consistency of analysis and reporting. More than a decade on the needs of modern drug development are reviewed, how imaging has evolved to support new drug development demands, the potential to translate state-of-the-art methods into routine tools and what is needed to enable the effective use of this broadening clinical trial toolset. In this review, we challenge the clinical and scientific imaging community to help refine existing clinical trial methods and innovate to deliver the next generation of techniques. Strong industry-academic partnerships and pre-competitive opportunities to co-ordinate efforts will ensure imaging technologies maintain a crucial role delivering innovative medicines to treat cancer.
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Affiliation(s)
| | - Paul Galette
- Telix Pharmaceuticals (US) Inc, Fishers, United States
| | | | | | | | - Andrew P. Brown
- Vale Imaging Consultancy Solutions, Harston, Cambridge, United Kingdom
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6
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Pham H, Dixon E. Integration of Next-Generation Sequencing in the Surgical Management of Colorectal Liver Metastasis. Ann Surg Oncol 2023; 30:6815-6823. [PMID: 37316745 DOI: 10.1245/s10434-023-13750-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2022] [Accepted: 06/04/2023] [Indexed: 06/16/2023]
Abstract
Hepatic resection remains the treatment of choice for colorectal liver metastases. The advancement of surgical technique and use of perioperative systemic therapy has expanded the number and complexity of patients eligible for surgical resection. In recent years, investigation into gene mutations, such as RAS/RAF pathway, have led to targeted therapies that have significantly improved outcomes. Next-generation sequencing allows analysis of large number of genes that may have potential prognostic relevance in the clinical setting. This review summarizes the current applications of next-generation sequencing technology in metastatic colorectal cancer, focusing on its prognostic implications on patient management.
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Affiliation(s)
- Helen Pham
- Department of Surgery, Faculty of Medicine, University of Calgary, Foothills Medical Centre, Calgary, AB, Canada.
| | - Elijah Dixon
- Department of Surgery, Faculty of Medicine, University of Calgary, Foothills Medical Centre, Calgary, AB, Canada
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7
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deSouza NM, van der Lugt A, Hall TJ, Sullivan D, Zahlmann G. Delivering a Quantitative Imaging Agenda. Cancers (Basel) 2023; 15:4219. [PMID: 37686495 PMCID: PMC10486970 DOI: 10.3390/cancers15174219] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2023] [Revised: 08/02/2023] [Accepted: 08/11/2023] [Indexed: 09/10/2023] Open
Abstract
In a digital image, each voxel contains quantitative information dependent on the technique used to generate the image [...].
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Affiliation(s)
- Nandita M. deSouza
- The Institute of Cancer Research, The Royal Marsden NHS Foundation Trust, London SW3 6JJ, UK
| | - Aad van der Lugt
- Department of Radiology and Nuclear Medicine, Erasmus MC University Medical Centre, 3015 GD Rotterdam, The Netherlands
| | - Timothy J. Hall
- Department of Medical Physics, University of Wisconsin, Madison, WI 53706, USA
| | - Daniel Sullivan
- Department of Radiology, Duke University Medical Center, Durham, NC 27710, USA
| | - Gudrun Zahlmann
- Independent Consultant for Quantitative Imaging Biomarkers Alliance (QIBA), Radiological Society of North America (RSNA), Oak Brook, IL 60523, USA
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8
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Eveslage M, Rassek P, Riegel A, Maksoud Z, Bauer J, Görlich D, Noto B. Diffusion-Weighted MRI for Treatment Response Assessment in Osteoblastic Metastases-A Repeatability Study. Cancers (Basel) 2023; 15:3757. [PMID: 37568573 PMCID: PMC10417276 DOI: 10.3390/cancers15153757] [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: 06/19/2023] [Revised: 07/19/2023] [Accepted: 07/21/2023] [Indexed: 08/13/2023] Open
Abstract
The apparent diffusion coefficient (ADC) is a candidate marker of treatment response in osteoblastic metastases that are not evaluable by morphologic imaging. However, it is unclear whether the ADC meets the basic requirement for reliable treatment response evaluation, namely a low variance of repeated measurements in relation to the differences found between viable and nonviable metastases. The present study addresses this question by analyzing repeated in vivo ADCmedian measurements of 65 osteoblastic metastases in nine patients, as well as phantom measurements. PSMA-PET served as a surrogate for bone metastasis viability. Measures quantifying repeatability were calculated and differences in mean ADC values according to PSMA-PET status were examined. The relative repeatability coefficient %RC of ADCmedian measurements was 5.8% and 12.9% for phantom and in vivo measurements, respectively. ADCmedian values of bone metastases ranged from 595×10-6mm2/s to 2090×10-6mm2/s with an average of 63% higher values in nonviable metastases compared with viable metastases (p < 0.001). ADC shows a small repeatability coefficient in relation to the difference in ADC values between viable and nonviable metastases. Therefore, ADC measurements fulfill the technical prerequisite for reliable treatment response evaluation in osteoblastic metastases.
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Affiliation(s)
- Maria Eveslage
- Institute of Biostatistics and Clinical Research, University of Münster, 48149 Münster, Germany
| | - Philipp Rassek
- Department of Nuclear Medicine, University Hospital Münster, 48149 Münster, Germany
| | - Arne Riegel
- Clinic for Radiology, University Hospital Münster, 48149 Münster, Germany
| | - Ziad Maksoud
- Clinic for Radiology, University Hospital Münster, 48149 Münster, Germany
| | - Jochen Bauer
- Clinic for Radiology, University Hospital Münster, 48149 Münster, Germany
| | - Dennis Görlich
- Institute of Biostatistics and Clinical Research, University of Münster, 48149 Münster, Germany
| | - Benjamin Noto
- Institute of Biostatistics and Clinical Research, University of Münster, 48149 Münster, Germany
- Department of Nuclear Medicine, University Hospital Münster, 48149 Münster, Germany
- Clinic for Radiology, University Hospital Münster, 48149 Münster, Germany
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9
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Gouel P, Callonnec F, Levêque É, Valet C, Blôt A, Cuvelier C, Saï S, Saunier L, Pepin LF, Hapdey S, Libraire J, Vera P, Viard B. Evaluation of the capability and reproducibility of RECIST 1.1. measurements by technologists in breast cancer follow-up: a pilot study. Sci Rep 2023; 13:9148. [PMID: 37277412 DOI: 10.1038/s41598-023-36315-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2022] [Accepted: 05/31/2023] [Indexed: 06/07/2023] Open
Abstract
The evaluation of tumor follow-up according to RECIST 1.1 has become essential in clinical practice given its role in therapeutic decision making. At the same time, radiologists are facing an increase in activity while facing a shortage. Radiographic technologists could contribute to the follow-up of these measures, but no studies have evaluated their ability to perform them. Ninety breast cancer patients were performed three CT follow-ups between September 2017 and August 2021. 270 follow-up treatment CT scans were analyzed including 445 target lesions. The rate of agreement of classifications RECIST 1.1 between five technologists and radiologists yielded moderate (k value between 0.47 and 0.52) and substantial (k value = 0.62 and k = 0.67) agreement values. 112 CT were classified as progressive disease (PD) by the radiologists, and 414 new lesions were identified. The analysis showed a percentage of strict agreement of progressive disease classification between reader-technologists and radiologists ranging from substantial to almost perfect agreement (range 73-97%). Analysis of intra-observer agreement was strong at almost perfect (k > 0.78) for 3 technologists. These results are encouraging regarding the ability of selected technologists to perform measurements according to RECIST 1.1 criteria by CT scan with good identification of disease progression.
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Affiliation(s)
- Pierrick Gouel
- Department of Medical Imaging, Henri Becquerel Cancer Center, Rouen, Normandy, France.
- QuantIF-LITIS EA4108, University of Rouen, Rouen, Normandy, France.
| | - Françoise Callonnec
- Department of Medical Imaging, Henri Becquerel Cancer Center, Rouen, Normandy, France
| | - Émilie Levêque
- Department of Statistics and Clinical Research Unit, Henri Becquerel Cancer Center, Rouen, Normandy, France
| | - Céline Valet
- Department of Medical Imaging, Henri Becquerel Cancer Center, Rouen, Normandy, France
| | - Axelle Blôt
- Department of Medical Imaging, Henri Becquerel Cancer Center, Rouen, Normandy, France
| | - Clémence Cuvelier
- Department of Medical Imaging, Henri Becquerel Cancer Center, Rouen, Normandy, France
| | - Sonia Saï
- Department of Medical Imaging, Henri Becquerel Cancer Center, Rouen, Normandy, France
| | - Lucie Saunier
- Department of Medical Imaging, Henri Becquerel Cancer Center, Rouen, Normandy, France
| | - Louis-Ferdinand Pepin
- Department of Statistics and Clinical Research Unit, Henri Becquerel Cancer Center, Rouen, Normandy, France
| | - Sébastien Hapdey
- Department of Medical Imaging, Henri Becquerel Cancer Center, Rouen, Normandy, France
- QuantIF-LITIS EA4108, University of Rouen, Rouen, Normandy, France
| | - Julie Libraire
- Department of Statistics and Clinical Research Unit, Henri Becquerel Cancer Center, Rouen, Normandy, France
| | - Pierre Vera
- Department of Medical Imaging, Henri Becquerel Cancer Center, Rouen, Normandy, France
- QuantIF-LITIS EA4108, University of Rouen, Rouen, Normandy, France
| | - Benjamin Viard
- Department of Medical Imaging, Henri Becquerel Cancer Center, Rouen, Normandy, France
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Iannessi A, Beaumont H. Breaking down the RECIST 1.1 double read variability in lung trials: What do baseline assessments tell us? Front Oncol 2023; 13:988784. [PMID: 37007064 PMCID: PMC10060958 DOI: 10.3389/fonc.2023.988784] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2022] [Accepted: 02/03/2023] [Indexed: 03/18/2023] Open
Abstract
BackgroundIn clinical trials with imaging, Blinded Independent Central Review (BICR) with double reads ensures data blinding and reduces bias in drug evaluations. As double reads can cause discrepancies, evaluations require close monitoring which substantially increases clinical trial costs. We sought to document the variability of double reads at baseline, and variabilities across individual readers and lung trials.Material and methodsWe retrospectively analyzed data from five BICR clinical trials evaluating 1720 lung cancer patients treated with immunotherapy or targeted therapy. Fifteen radiologists were involved. The variability was analyzed using a set of 71 features derived from tumor selection, measurements, and disease location. We selected a subset of readers that evaluated ≥50 patients in ≥two trials, to compare individual reader’s selections. Finally, we evaluated inter-trial homogeneity using a subset of patients for whom both readers assessed the exact same disease locations. Significance level was 0.05. Multiple pair-wise comparisons of continuous variables and proportions were performed using one-way ANOVA and Marascuilo procedure, respectively.ResultsAcross trials, on average per patient, target lesion (TL) number ranged 1.9 to 3.0, sum of tumor diameter (SOD) 57.1 to 91.9 mm. MeanSOD=83.7 mm. In four trials, MeanSOD of double reads was significantly different. Less than 10% of patients had TLs selected in completely different organs and 43.5% had at least one selected in different organs. Discrepancies in disease locations happened mainly in lymph nodes (20.1%) and bones (12.2%). Discrepancies in measurable disease happened mainly in lung (19.6%). Between individual readers, the MeanSOD and disease selection were significantly different (p<0.001). In inter-trials comparisons, on average per patient, the number of selected TLs ranged 2.1 to 2.8, MeanSOD 61.0 to 92.4 mm. Trials were significantly different in MeanSOD (p<0.0001) and average number of selected TLs (p=0.007). The proportion of patients having one of the top diseases was significantly different only between two trials for lung. Significant differences were observed for all other disease locations (p<0.05).ConclusionsWe found significant double read variabilities at baseline, evidence of reading patterns and a means to compare trials. Clinical trial reliability is influenced by the interplay of readers, patients and trial design.
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Belkouchi Y, Nebot-Bral L, Lawrance L, Kind M, David C, Ammari S, Cournède PH, Talbot H, Vuagnat P, Smolenschi C, Kannouche PL, Chaput N, Lassau N, Hollebecque A. Predicting immunotherapy outcomes in patients with MSI tumors using NLR and CT global tumor volume. Front Oncol 2022; 12:982790. [PMID: 36387101 PMCID: PMC9641225 DOI: 10.3389/fonc.2022.982790] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Accepted: 10/04/2022] [Indexed: 08/31/2023] Open
Abstract
BACKGROUND Anti-PD-(L)1 treatment is indicated for patients with mismatch repair-deficient (MMRD) tumors, regardless of tumor origin. However, the response rate is highly heterogeneous across MMRD tumors. The objective of the study is to find a score that predicts anti-PD-(L)1 response in patients with MMRD tumors. METHODS Sixty-one patients with various origin of MMRD tumors and treated with anti-PD-(L)1 were retrospectively included in this study. An expert radiologist annotated all tumors present at the baseline and first evaluation CT-scans for all the patients by circumscribing them on their largest axial axis (single slice), allowing us to compute an approximation of their tumor volume. In total, 2120 lesions were annotated, which led to the computation of the total tumor volume for each patient. The RECIST sum of target lesions' diameters and neutrophile-to-lymphocyte (NLR) were also reported at both examinations. These parameters were determined at baseline and first evaluation and the variation between the first evaluation and baseline was calculated, to determine a comprehensive score for overall survival (OS) and progression-free survival (PFS). RESULTS Total tumor volume at baseline was found to be significantly correlated to the OS (p-value: 0.005) and to the PFS (p-value:<0.001). The variation of the RECIST sum of target lesions' diameters, total tumor volume and NLR were found to be significantly associated to the OS (p-values:<0.001, 0.006,<0.001 respectively) and to the PFS (<0.001,<0.001, 0.007 respectively). The concordance score combining total tumor volume and NLR variation was better at stratifying patients compared to the tumor volume or NLR taken individually according to the OS (pairwise log-rank test p-values: 0.033,<0.001, 0.002) and PFS (pairwise log-rank test p-values: 0.041,<0.001, 0.003). CONCLUSION Total tumor volume appears to be a prognostic biomarker of anti-PD-(L)1 response to immunotherapy in metastatic patients with MMRD tumors. Combining tumor volume and NLR with a simple concordance score stratifies patients well according to their survival and offers a good predictive measure of response to immunotherapy.
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Affiliation(s)
- Younes Belkouchi
- Laboratoire d’Imagerie Biomédicale Multimodale Paris-Saclay (BIOMAPS), UMR 1281, Université Paris-Saclay, Inserm, CNRS, CEA, Villejuif, France
- OPtimisation Imagerie et Santé (OPIS), Inria, CentraleSupélec, Université Paris-Saclay, Gif-Sur-Yvette, France
| | - Laetitia Nebot-Bral
- UMR9019 - CNRS, Intégrité du Génome et Cancer, Université Paris-Saclay, Gustave Roussy, Villejuif, France
| | - Littisha Lawrance
- Laboratoire d’Imagerie Biomédicale Multimodale Paris-Saclay (BIOMAPS), UMR 1281, Université Paris-Saclay, Inserm, CNRS, CEA, Villejuif, France
| | - Michele Kind
- Département d’Imagerie Médicale, Institut Bergonié, Bordeaux, France
| | - Clémence David
- Laboratoire d’Imagerie Biomédicale Multimodale Paris-Saclay (BIOMAPS), UMR 1281, Université Paris-Saclay, Inserm, CNRS, CEA, Villejuif, France
| | - Samy Ammari
- Laboratoire d’Imagerie Biomédicale Multimodale Paris-Saclay (BIOMAPS), UMR 1281, Université Paris-Saclay, Inserm, CNRS, CEA, Villejuif, France
- Département d’Imagerie, Gustave Roussy, Université Paris Saclay, Villejuif, France
| | - Paul-Henry Cournède
- Mathématiques et Informatique pour la Complexité et les Systèmes (MICS), CentraleSupélec, Université Paris-Saclay, Gif-Sur-Yvette, France
| | - Hugues Talbot
- OPtimisation Imagerie et Santé (OPIS), Inria, CentraleSupélec, Université Paris-Saclay, Gif-Sur-Yvette, France
| | - Perrine Vuagnat
- Département d’Innovation Thérapeutique et d’Essais Précoces (DITEP), Gustave Roussy, Université Paris Saclay, Villejuif, France
| | - Cristina Smolenschi
- Département d’Innovation Thérapeutique et d’Essais Précoces (DITEP), Gustave Roussy, Université Paris Saclay, Villejuif, France
| | - Patricia L. Kannouche
- UMR9019 - CNRS, Intégrité du Génome et Cancer, Université Paris-Saclay, Gustave Roussy, Villejuif, France
| | - Nathalie Chaput
- UMR9019 - CNRS, Intégrité du Génome et Cancer, Université Paris-Saclay, Gustave Roussy, Villejuif, France
- Université Paris-Saclay, Faculté de Pharmacie, Chatenay-Malabry, France
- Laboratoire d’Immunomonitoring en Oncologie, Gustave Roussy, Villejuif, France
| | - Nathalie Lassau
- Laboratoire d’Imagerie Biomédicale Multimodale Paris-Saclay (BIOMAPS), UMR 1281, Université Paris-Saclay, Inserm, CNRS, CEA, Villejuif, France
- Département d’Imagerie, Gustave Roussy, Université Paris Saclay, Villejuif, France
| | - Antoine Hollebecque
- Département d’Innovation Thérapeutique et d’Essais Précoces (DITEP), Gustave Roussy, Université Paris Saclay, Villejuif, France
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