Response of gastrointestinal stromal tumors (GISTs) to imatinib by Choi criteria and response evaluation criteria in solid tumors (RECIST) as surrogates for survival and time to progression

2006 ◽  
Vol 24 (18_suppl) ◽  
pp. 9506-9506 ◽  
Author(s):  
R. S. Benjamin ◽  
H. Choi ◽  
H. A. Macapinlac ◽  
M. A. Burgess ◽  
S. R. Patel ◽  
...  
Keyword(s):  
Tumor Size ◽  
Evaluation Criteria ◽  
Poor Responders ◽  
Contrast Enhanced Ct ◽  
Contrast Enhanced ◽  
Choi Criteria ◽  
Enhanced Ct ◽  
Pre Treatment ◽  
Response Group

9506 Background: Recent studies have demonstrated that RECIST is insensitive in evaluating GIST’s treated with imatinib. We have demonstrated in a small group of patients that a good response by Choi Criteria, i.e., a 10% decrease in unidimensional tumor size or a 15% decrease in tumor density on contrast-enhanced CT, correlated well with good response by PET (Proc. ASCO 22:819, 2003) and was more predictive of time to tumor progression (TTP) than response by RECIST (CTOS 2004). The aim of this study was to validate the correlation with disease-specific survival (DSS) and TTP with follow-up updated to 5-years. Methods: We evaluated 98 patients treated with imatinib for recurrent or metastatic GIST at our institution from December 2000 to September 2001 by RECIST and Choi criteria. All patients had pre-treatment and initial 2-monthly follow-up CT’s. DSS and TTP were analyzed by response category. Results: There were 28 (48%) good responders by RECIST and 30 (52%) poor responders. There were 49 (84%) good responders by Choi criteria, and 9 (16%) poor responders. Patients with good response by Choi criteria on CT at 8 weeks after treatment had significantly improved DSS (P = 0.04) in contrast to those with complete or partial response at any time by RECIST (P = 0.45). Similarly, TTP was significantly correlated with Choi response group (P = 0.01) but not with response group by RECIST (P = 0.74). Conclusions: Choi response criteria, incorporating tumor density and using small changes in tumor size on CT, are more sensitive and more accurate than RECIST in assessing the response of GISTs to imatinib mesylate and should be routinely incorporated into future studies of GIST therapy. Good response is detected earlier by Choi criteria and is a valid surrogate for DSS and TTP. We should desist using RECIST, at least in GIST. (Supported in part by NCI contracts U01-CA70172–01 and N01-CM-17003) [Table: see text]

We Should Desist Using RECIST, at Least in GIST

2007 ◽  
Vol 25 (13) ◽  
pp. 1760-1764 ◽  
Author(s):  
Robert S. Benjamin ◽  
Haesun Choi ◽  
Homer A. Macapinlac ◽  
Michael A. Burgess ◽  
Shreyaskumar R. Patel ◽  
...  
Keyword(s):  
Evaluation Criteria ◽  
Response Criteria ◽  
Training Set ◽  
Data Set ◽  
Contrast Enhanced Ct ◽  
Positron Emission ◽  
Contrast Enhanced ◽  
Choi Criteria ◽  
Enhanced Ct ◽  
Response Group

Purpose Response Evaluation Criteria in Solid Tumors (RECIST) are insensitive in evaluating imatinib-treated gastrointestinal stromal tumors (GISTs). Response by Choi criteria, a 10% decrease in size or a 15% decrease in density on contrast-enhanced CT, correlated well in a small training set of patients who showed response as measured by positron emission tomography, and was more predictive of time to tumor progression (TTP) than response by RECIST. This study was designed to validate these observations in an independent data set. Patients and Methods Fifty-eight patients with imatinib-treated GISTs were evaluated by RECIST and Choi criteria. TTP was compared with TTP in the training set. Patients were analyzed initially with follow-up to 28 months, extended to 60 months for survival analysis. Results Patients who met Choi response criteria on CT at 2 months had significantly better TTP than those who did not (P = .0002), whereas response group by RECIST was not significantly correlated with TTP. Even when the 98 patients from both sets were analyzed together, the response group by RECIST did not correlate significantly with TTP, whereas response group by Choi criteria did correlate significantly with TTP. Disease-specific survival (DSS) was also significantly correlated with response group by Choi criteria (P = .04), but not with response group by RECIST. Conclusion Choi response criteria are reproducible, more sensitive, and more precise than RECIST in assessing the response of GISTs to imatinib mesylate. Response by Choi criteria, unlike response by RECIST, correlates significantly with TTP and DSS. Response by Choi criteria should be incorporated routinely into future studies of GIST therapy. We should desist using RECIST, at least in GIST.

scholarly journals Incremental Role of 18F-FDG PET with contrast enhanced CT (PET-CECT) in detection of recurrence of carcinoma cervix

2016 ◽  
Author(s):  
S. Dash ◽  
A. Goel ◽  
S. Sogani
Keyword(s):  
Fdg Pet ◽  
Carcinoma Cervix ◽  
Histopathological Correlation ◽  
Contrast Enhanced Ct ◽  
Contrast Enhanced ◽  
Enhanced Ct ◽  
Radiologic Imaging ◽  
18F Fdg

Purpose: To evaluate the role of 18F-FDG PET with contrast enhanced CT (PET-CECT) in early detection of recurrence in follow up patients of carcinoma cervix. Methods: Patients with histopathologically proven carcinoma cervix who underwent chemotherapy, radiotherapy and/or surgery and on follow up were recruited in the study. Fifty-two patients underwent 18F-FDG PET-CECT for detection of recurrence. The median age was 51.5 (average = 53.4) years. PET-CECT studies were evaluated and analyzed separately by an experienced nuclear medicine physician and a radiologist independently. The physicians were blinded for the patient history. PET-CECT results were validated with histopathological correlation, conventional radiologic imaging/follow up PET-CECT study and clinical follow up. Results: Out of 52 patients, 34 patients were reported as positive for recurrence, 17 of these were having active local recurrence and 31 patients had regional lymph nodal metastases, 14 patients had distant metastases (out of them 6 patients had distant lymph node metastases, 6 had pulmonary metastases, 4 had skeletal metastases and two had liver metastases). Remaining 18 patients were reported as negative for recurrence. The lung was the most common site for distant metastasis. Patient were then further evaluated based on histopathological correlation, conventional radiologic imaging and follow up PET-CECT scan and five were found to be false positive and one patient was identified as false negative. The sensitivity, specificity, positive and negative predictive value were derived to be 96.7%, 77.3%, 85.3% and 94.4%, respectively. Accuracy was calculated to be 88.5%. Conclusions: 18F-FDG PET-CECT is a very useful non-invasive modality for the early detection of recurrence and metastatic workup in patients with carcinoma cervix with a very high sensitivity and negative predictive value. It is also useful in targeting biopsy sites in suspected cases of recurrence.

scholarly journals Clinical application of contrast-enhanced ultrasound after percutaneous renal tumor ablation

2019 ◽  
Vol 92 (1103) ◽  
pp. 20190183 ◽  
Author(s):  
Fang Guo ◽  
Bing Hu ◽  
Lei Chen ◽  
Jia Li
Keyword(s):  
Local Recurrence ◽  
Tumor Ablation ◽  
Renal Tumors ◽  
Ablation Zone ◽  
Recurrent Tumors ◽  
Contrast Enhanced Ct ◽  
Contrast Enhanced ◽  
Enhanced Ct ◽  
Complete Tumor

Objective: To evaluate the effectiveness of contrast-enhanced ultrasound (CEUS) in detecting incomplete ablation and local recurrence of renal tumors after percutaneous radiofrequency ablation (RFA). Methods: 31 patients were included for RFA treatment and underwent CEUS examination after RFA, ablation zone and contrast distribution in the ablation area were observed, CEUS images were compared with enhanced CT/MRI images to determine the residual tumors and local recurrence of renal tumors. Results: The average maximum diameters of the tumor and the ablation zone after the first RFA were 32.3 ± 14.7 mm and 35.9 ± 12.2 mm, respectively. A higher rate of complete tumor ablation was achieved if the ablation zone was larger than the primary tumor (p = 0.026). Within 1 month after RFA, contrast-enhanced CT/MRI examinations demonstrated incomplete ablation in 9 of 31 patients (29.0%), while CEUS revealed incomplete ablation in 8 of 31 patients (25.8%). The sensitivity, specificity, positive predictive value and negative predictive value of CEUS in evaluating complete ablation of renal tumors were 88.9%, 100%, 100%, 95.7%, respectively. During the follow-up period, local recurrence was reported in 2 (7.4%) of the 27 patients with complete tumor ablation. Tumor recurrence signs in the two patients were identified by both CEUS and contrast-enhanced CT/MRI. Therefore, both the sensitivity and specificity of CEUS for the evaluation of tumor recurrence were 100%. Conclusion: After percutaneous RFA of renal tumors, the effectiveness of CEUS in the follow-up assessment of residual and recurrent tumors is basically the same as that of contrast-enhanced CT/MRI. Advances in knowledge: In this study, we evaluated the effectiveness of CEUS in the follow-up assessment of residual and recurrent tumors after RFA is basically the same as that of contrast-enhanced CT/MRI. Combining multiple follow-up methods may improve the detection rate of residual or recurrent tumors.

Mixed neuroendocrine-non-neuroendocrine neoplasms (MiNEN) of pancreas: a rare entity—worth to note

2020 ◽  
Vol 13 (4) ◽  
pp. e234855 ◽  
Author(s):  
Bharti Varshney ◽  
Jyotsna Naresh Bharti ◽  
Vaibhav Kumar Varshney ◽  
Taruna Yadav
Keyword(s):  
Histopathological Examination ◽  
Neuroendocrine Tumour ◽  
Pancreatic Head ◽  
Ductal Adenocarcinoma ◽  
Neuroendocrine Neoplasms ◽  
Contrast Enhanced Ct ◽  
Contrast Enhanced ◽  
Enhanced Ct ◽  
Rare Malignancy

Mixed adenocarcinoma with neuroendocrine tumour of pancreas has been reported infrequently and consists of both epithelial and neuroendocrine component. We encountered an 81-year-old male patient who presented with clinical features of painful progressive jaundice for 1 month. Contrast-enhanced CT abdomen reported a mass in the pancreatic head with dilated common bile duct and pancreatic duct. He underwent pancreatoduodenectomy and histopathological examination revealed two different tumours: ductal adenocarcinoma admixed with neuroendocrine tumour of pancreas. He received adjuvant chemotherapy, and at the end of 1-year follow-up, he has no recurrence. Here, we reported this rare malignancy of pancreas for which pancreatoduodenectomy was done and diagnosed on histopathology with immunohistochemistry.

Müllerianosis of the urinary bladder with unilateral complete renal agenesis: a rare coincidental finding causing delayed presentation

2020 ◽  
Vol 13 (7) ◽  
pp. e235217
Author(s):  
Shanmugasundaram Rajaian ◽  
Lakshman Murugasen ◽  
Deepti Jain ◽  
Srinivas Chakravarthy Narasimhachar
Keyword(s):  
Urinary Bladder ◽  
Benign Lesion ◽  
Left Kidney ◽  
Scar Tissue ◽  
Delayed Presentation ◽  
Contrast Enhanced Ct ◽  
Contrast Enhanced ◽  
Enhanced Ct ◽  
Ureteric Orifice

Müllerianosis is a rare benign lesion of the urinary bladder, which is constituted by two or more of the Müllerian-duct-derived tissues. We report a 45-year-old perimenopausal multiparous woman presenting with occasional episodes of dysuria and lower abdominal discomfort of recent duration. Ultrasound examination revealed a well-defined lesion in urinary bladder and the absence of left kidney. Contrast-enhanced CT of the abdomen confirmed the findings. During diagnostic cystoscopy, haemorrhagic polypoidal lesions were noted in the left side of the posterolateral wall and dome of urinary bladder along with the absence of left ureteric orifice. Transurethral resection of the bladder lesions was done and histology examination confirmed the diagnosis of Müllerianosis. She was administered Luteinizing hormone-releasing hormone (LHRH) agonist monthly. At 1 year of follow-up, cystoscopy showed only scar tissue. The case was reported for the rarity of Müllerianosis noted in a patient with unilateral agenesis of kidney, a possible cause of delayed presentation.

Reduction in Tumor Stain at 2 Weeks after Treatment Initiation Is a Predictor of the Efficacy of Lenvatinib in Patients with Unresectable Hepatocellular Carcinoma

Oncology ◽  
2020 ◽  
Vol 98 (11) ◽  
pp. 779-786
Author(s):  
Hideo Kunimoto ◽  
Satoshi Shakado ◽  
Takashi Tanaka ◽  
Kazuhide Takata ◽  
Ryo Yamauchi ◽  
...  
Keyword(s):  
Hepatocellular Carcinoma ◽  
Dose Reduction ◽  
Tumor Size ◽  
Treatment Efficacy ◽  
Treatment Initiation ◽  
Advanced Hepatocellular Carcinoma ◽  
Efficacy Evaluation ◽  
Contrast Enhanced Ct ◽  
Contrast Enhanced ◽  
Enhanced Ct

<b><i>Background and Aims:</i></b> Lenvatinib is an oral anticancer drug for patients with unresectable advanced hepatocellular carcinoma (HCC). We evaluated whether a reduction in tumor stain at 2 weeks after lenvatinib treatment in patients with unresectable HCC is a predictor of early treatment efficacy at 12 weeks. <b><i>Patients and Methods:</i></b> Of the 23 patients who initiated lenvatinib treatment between April 2018 and January 2019, treatment efficacy was measured in 15 patients for more than 12 weeks after treatment. Changes in tumor stain, tumor size on contrast-enhanced computed tomography (CT), and serum levels of tumor markers were evaluated 2 weeks after lenvatinib treatment. Therapeutic efficacy was assessed by tumor stain and tumor size by contrast-enhanced CT within the first 12 weeks, according to the modified Response Evaluation Criteria in Solid Tumors (mRECIST) guidelines. <b><i>Results:</i></b> At 12 weeks, efficacy evaluation of 15 patients revealed that 11 of them experienced partial responses, for a response rate of 73.3%. In the first 2 weeks, 13 patients (86.7%) experienced a decreased tumor stain, including 10 responders (90.9%) and 3 non-responders (75.0%). All patients in the non-responder group had required a lenvatinib dose reduction due to adverse events within 12 weeks. On contrast-enhanced CT, the change rate of tumor stain to HCC at 2 weeks after treatment was &#x3c;0.8 among 10 responders (90.9%) and 1 non-responder (25.0%; <i>p</i> = 0.033). No significant differences between responders and non-responders were observed with regard to most characteristics at baseline and at 2 weeks after treatment initiation. However, significant differences were observed between groups in the presence or absence of a dose suspension period, the presence or absence of lenvatinib dose reduction from the maximum value during the first 2 weeks, and decreased tumor stain at 2 weeks after treatment initiation. <b><i>Conclusion:</i></b> Reduction in tumor stain at 2 weeks after lenvatinib treatment may be an early biomarker of efficacy at 12 weeks in patients with unresectable HCC.

A comparison of liver MRI and contrast enhanced CT as standard workup before treatment for rectal cancer in usual care – a Retrospective Study

2021 ◽  
Vol 17 ◽  
Author(s):  
Jennifer Park ◽  
Mattias Block ◽  
David Bock ◽  
Peter Kälebo ◽  
Peter Nilsson ◽  
...  
Keyword(s):  
Rectal Cancer ◽  
Retrospective Study ◽  
Usual Care ◽  
Prospective Trial ◽  
Cancer Metastases ◽  
Contrast Enhanced Ct ◽  
Contrast Enhanced ◽  
Enhanced Ct ◽  
Pre Treatment ◽  
Magnetic Resonance Imaging Mri

Background: The liver is the most common site for rectal cancer metastases. Recommended standard pre-treatment workup has involved computed tomography (CT) for abdominal metastases. However, few hospitals have replaced this with magnetic resonance imaging (MRI). Introduction: The aim of this study was to compare MRI with CT as an index examination of the liver in the pre-treatment workup in usual care. The primary endpoint was the need for supplementary liver investigations. Result: A total of 320 patients were included, and 293 were available for analysis. Some 175 and 118 patients had undergone CT and MRI, respectively, as their index pretreatment liver examination. Thirty-four (19.4%) in the CT group and 6 (5.1%) patients in the MRI group underwent supplementary liver investigation due to inconclusive index examination (RR 3.82, 95% CI: 1.66;8.81, p=0.0017). Median time (q1;q3) from index examination to start of treatment was 50 (36;68) days in the CT group and 34 (27;45) days in the MRI group. Conclusion: This retrospective study of two modalities within usual care found that MRI of the liver as index radiological workup before treatment for rectal cancer was associated with fewer supplementary liver investigations and a shorter time to start treatment. Based on these findings, a prospective trial should be undertaken before implementing MRI as a standard.

Does FDG-PET/CT Obviate the Need for Standard Diagnostic Contrast-Enhanced CT in Patients with Lymphoma?.

Blood ◽  
2007 ◽  
Vol 110 (11) ◽  
pp. 2329-2329
Author(s):  
Rebecca L. Elstrom ◽  
Richard K.J. Brown
Keyword(s):  
Ct Scan ◽  
Fdg Pet ◽  
Contrast Enhanced Ct ◽  
Contrast Enhanced ◽  
Pet Ct ◽  
Enhanced Ct ◽  
Fdg Pet Ct ◽  
Lymphoma Therapy ◽  
Diagnostic Ct

Abstract Background and Significance: Positron emission tomography using 18-fluoro-2-deoxyglucose (FDG-PET) is useful in the staging and follow up of patients with lymphoma, and has been shown in several studies to be more accurate than computed tomography (CT). These studies have, however, demonstrated a continued role for CT in staging and restaging of lymphoma, and the two modalities are complementary. Increasingly, FDG-PET is performed in conjunction with a low radiation dose, non-contrast CT scan for attenuation correction and localization of lesions. Currently, many patients undergo both FDG-PET/CT and standard diagnostic, contrast enhanced CT, at a significant cost both financially and in terms of radiation exposure. In this study, we evaluated the clinical utility of performing both studies in patients with lymphoma. Study Design and Methods: We retrospectively identified patients with lymphoma who had undergone both FDG-PET/CT and diagnostic, contrast-enhanced CT (a scan pair) for either staging or restaging following treatment. Patients were included if the two imaging studies were performed within 6 weeks of each other with no intervening anti-lymphoma therapy. We compared the results of the two studies, identifying findings that were detected in either FDG-PET/CT or diagnostic CT scan but not both. Discrepancies were considered clinically significant if they were determined to be related either to lymphoma or another disease process which potentially required intervention. Results: Eighty-nine scan pairs which met the criteria were identified in 75 patients. Sixty-one scan pairs were performed for staging, and 28 were performed for treatment follow up. FDG-PET/CT detected additional potentially clinically relevant lesions over CT in 30 patients, of which 11 demonstrated increased clinical stage. Lymphoma therapy was changed based on FDG-PET/CT findings in 2 patients, and in one patient an occult rectal cancer was detected. In contrast, diagnostic CT detected 5 potentially clinically relevant findings, including 2 incidental findings (one definite and one possible venous thrombosis), and 3 patients with splenic lesions. Of the patients with splenic lesions, one was found on follow up to be definitely not related to lymphoma, and the nature of the splenic lesions in the other two patients remained indeterminate. No patient had a change of stage or lymphoma therapy based on diagnostic CT scan, and one patient was treated with anticoagulation based on CT findings. In the subgroup of scan pairs performed for follow up, diagnostic CT added clinically relevant information in none of the patients. Conclusion: In our series of patients, diagnostic contrast-enhanced CT scan did not contribute to staging or restaging of lymphoma when performed concurrently with FDG-PET/CT. Two clinically important incidental findings were detected by CT alone, of which one led to intervention.

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