Published Online:https://doi.org/10.1148/rg.335125214

Accurate radiologic assessment of tumor response based on treatment and tumor type is vital for both effective treatment and the development of new targeted therapies.

There has been a proliferation and divergence of imaging-based tumor-specific response criteria over the past 3 decades whose purpose is to achieve objective assessment of treatment response in oncologic clinical trials. The World Health Organization (WHO) criteria, published in 1981, were the first response criteria and made use of bidimensional measurements of tumors. The Response Evaluation Criteria in Solid Tumors (RECIST) were created in 2000 and revised in 2009. The RECIST criteria made use of unidimensional measurements and addressed several pitfalls and limitations of the original WHO criteria. Both the WHO and RECIST criteria were developed during the era of cytotoxic chemotherapeutic agents and are still widely used. However, treatment strategies changed over the past decade, and the limitations of using tumor size alone in patients undergoing targeted therapy (including arbitrarily determined cutoff values to categorize tumor response and progression, lack of information about changes in tumor attenuation, inability to help distinguish viable tumor from nonviable components, and inconsistency of size measurements) necessitated revision of these criteria. More recent criteria that are used for targeted therapies include the Choi response criteria for gastrointestinal stromal tumor, modified RECIST criteria for hepatocellular carcinoma, and Immune-related Response Criteria for melanoma. The Cheson criteria and Positron Emission Tomography Response Criteria in Solid Tumors make use of positron emission tomography to provide functional information and thereby help determine tumor viability. As newer therapeutic agents and approaches become available, it may be necessary to further modify existing anatomy-based response-assessment methodologies, verify promising functional imaging methods in large prospective trials, and investigate new quantitative imaging technologies.

© RSNA, 2013

References

  • 1 World Health Organization. WHO handbook for reporting results of cancer treatment. Geneva, Switzerland: World Health Organization, 1979. Google Scholar
  • 2 Miller AB, Hoogstraten B, Staquet M, Winkler A. Reporting results of cancer treatment. Cancer 1981; 47(1):207–214. Crossref, MedlineGoogle Scholar
  • 3 Therasse P, Arbuck SG, Eisenhauer EA, et al.. New guide lines to evaluate the response to treatment in solid tumors. European Organization for Research and Treatment of Cancer, National Cancer Institute of the United States, National Cancer Institute of Canada. J Natl Cancer Inst 2000;92(3):205–216. Crossref, MedlineGoogle Scholar
  • 4 James K, Eisenhauer E, Christian M, et al.. Measuring response in solid tumors: unidimensional versus bidimensional measurement. J Natl Cancer Inst 1999;91(6):523–528. Crossref, MedlineGoogle Scholar
  • 5 Eisenhauer EA, Therasse P, Bogaerts J, et al.. New response evaluation criteria in solid tumours: revised RECIST guideline (version 1.1). Eur J Cancer 2009;45(2):228–247. Crossref, MedlineGoogle Scholar
  • 6 Bogaerts J, Ford R, Sargent D, et al.. Individual patient data analysis to assess modifications to the RECIST criteria. Eur J Cancer 2009;45(2):248–260. Crossref, MedlineGoogle Scholar
  • 7 Erasmus JJ, Gladish GW, Broemeling L, et al.. Interobserver and intraobserver variability in measurement of non-small-cell carcinoma lung lesions: implications for assessment of tumor response. J Clin Oncol 2003;21(13):2574–2582. Crossref, MedlineGoogle Scholar
  • 8 Zhao B, Schwartz LH, Moskowitz CS, Ginsberg MS, Rizvi NA, Kris MG. Lung cancer: computerized quantification of tumor response—initial results. Radiology 2006;241(3):892–898. LinkGoogle Scholar
  • 9 Zhao B, Schwartz LH, Larson SM. Imaging surrogates of tumor response to therapy: anatomic and functional biomarkers. J Nucl Med 2009;50(2): 239–249. Crossref, MedlineGoogle Scholar
  • 10 Choi H, Charnsangavej C, de Castro Faria S, et al.. CT evaluation of the response of gastrointestinal stromal tumors after imatinib mesylate treatment: a quantitative analysis correlated with FDG PET findings. AJR Am J Roentgenol 2004;183(6):1619–1628. Crossref, MedlineGoogle Scholar
  • 11 Choi H, Charnsangavej C, Faria SC, et al.. Correlation of computed tomography and positron emission tomography in patients with metastatic gastrointestinal stromal tumor treated at a single institution with imatinib mesylate: proposal of new computed tomography response criteria. J Clin Oncol 2007;25(13):1753–1759. Crossref, MedlineGoogle Scholar
  • 12 Van den Abbeele AD, Badawi RD. Use of positron emission tomography in oncology and its potential role to assess response to imatinib mesylate therapy in gastrointestinal stromal tumors (GISTs). Eur J Cancer 2002;38(suppl 5):S60–S65. Crossref, MedlineGoogle Scholar
  • 13 Choi H. Response evaluation of gastrointestinal stromal tumors. Oncologist 2008;13(suppl 2):4–7. Crossref, MedlineGoogle Scholar
  • 14 Hong X, Choi H, Loyer EM, Benjamin RS, Trent JC, Charnsangavej C. Gastrointestinal stromal tumor: role of CT in diagnosis and in response evaluation and surveillance after treatment with imatinib. RadioGraphics 2006;26(2):481–495. LinkGoogle Scholar
  • 15 van der Veldt AA, Meijerink MR, van den Eertwegh AJ, Haanen JB, Boven E. Choi response criteria for early prediction of clinical outcome in patients with metastatic renal cell cancer treated with sunitinib. Br J Cancer 2010;102(5):803–809. Crossref, MedlineGoogle Scholar
  • 16 Stacchiotti S, Collini P, Messina A, et al.. High-grade soft-tissue sarcomas: tumor response assessment—pilot study to assess the correlation between radiologic and pathologic response by using RECIST and Choi criteria. Radiology 2009;251(2): 447–456. LinkGoogle Scholar
  • 17 Vossen JA, Buijs M, Kamel IR. Assessment of tumor response on MR imaging after locoregional therapy. Tech Vasc Interv Radiol 2006;9(3):125–132. Crossref, MedlineGoogle Scholar
  • 18 Llovet JM, Di Bisceglie AM, Bruix J, et al.. Design and endpoints of clinical trials in hepatocellular carcinoma. J Natl Cancer Inst 2008;100(10):698–711. Crossref, MedlineGoogle Scholar
  • 19 Forner A, Ayuso C, Varela M, et al.. Evaluation of tumor response after locoregional therapies in hepatocellular carcinoma: are response evaluation criteria in solid tumors reliable? Cancer 2009;115(3):616–623. Crossref, MedlineGoogle Scholar
  • 20 Bruix J, Sherman M, Llovet JM, et al.. Clinical management of hepatocellular carcinoma: conclusions of the Barcelona 2000 EASL conference. European Association for the Study of the Liver. J Hepatol 2001;35(3):421–430. Crossref, MedlineGoogle Scholar
  • 21 Bruix J, Sherman M; Practice Guidelines Committee, American Association for the Study of Liver Diseases. Management of hepatocellular carcinoma. Hepatology 2005;42(5):1208–1236. Crossref, MedlineGoogle Scholar
  • 22 Bos R, van Der Hoeven JJ, van Der Wall E, et al.. Biologic correlates of (18)fluorodeoxyglucose uptake in human breast cancer measured by positron emission tomography. J Clin Oncol 2002;20(2): 379–387. Crossref, MedlineGoogle Scholar
  • 23 Brücher BL, Weber W, Bauer M, et al.. Neoadjuvant therapy of esophageal squamous cell carcinoma: response evaluation by positron emission tomography. Ann Surg 2001;233(3):300–309. Crossref, MedlineGoogle Scholar
  • 24 Wahl RL, Jacene H, Kasamon Y, Lodge MA. From RECIST to PERCIST: evolving considerations for PET response criteria in solid tumors. J Nucl Med 2009;50(suppl 1):122S–150S. Crossref, MedlineGoogle Scholar
  • 25 Jochelson M, Mauch P, Balikian J, Rosenthal D, Canellos G. The significance of the residual mediastinal mass in treated Hodgkin’s disease. J Clin Oncol 1985;3(5):637–640. Crossref, MedlineGoogle Scholar
  • 26 Cheson BD, Pfistner B, Juweid ME, et al.. Revised response criteria for malignant lymphoma. J Clin Oncol 2007;25(5):579–586. Crossref, MedlineGoogle Scholar
  • 27 Wolchok JD, Hoos A, O’Day S, et al.. Guidelines for the evaluation of immune therapy activity in solid tumors: immune-related response criteria. Clin Cancer Res 2009;15(23):7412–7420. Crossref, MedlineGoogle Scholar
  • 28 Hoos A, Parmiani G, Hege K, et al.. A clinical development paradigm for cancer vaccines and related biologics. J Immunother 2007;30(1):1–15. Crossref, MedlineGoogle Scholar

Article History

Received: Dec 10 2012
Revision requested: Jan 3 2013
Revision received: Feb 22 2013
Accepted: Mar 6 2013
Published online: Aug 30 2013
Published in print: Sept 2013