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Radiologic Measurements of Tumor Response to Treatment: Practical Approaches and Limitations¹

¹ From the Department of Diagnostic Radiology, Institution for Molecular Medicine and Surgery, Karolinska University Hospital Solna and Karolinska Institute, Stockholm S-171 76, Sweden (C.S., H.J., M.R.T., K.B., Y.E.A., L.B.); the Department of Oncology, Karolinska University Hospital Solna (T.H.); the Medical Statistics Unit, Department of Learning, Informatics, Management and Ethics, Karolinska Institute (E.B.); the Department of Diagnostic Radiology, National Cancer Center East, Chiba, Japan (H.F.); and the Department of Radiology, Keio University School of Medicine, Tokyo, Japan (A.K.). Presented as an education exhibit at the 2006 RSNA Annual Meeting. Received April 9, 2007; revision requested May 15 and received July 12; accepted July 18. Supported by a Grant-in-Aid for Center of Excellence Research from the Ministry of Education, Culture, Sports, Science and Technology of Japan. All authors have no financial relationships to disclose. Address correspondence to C.S. (e-mail: Chikako.Tanaka{at}ki.se).

Objective response assessment is important to describe the treatment effect of anticancer drugs. Standardization by using a "common language" is also important for comparison of results from different trials. In contrast to clinical results, which can be subjective, diagnostic imaging provides a greater opportunity for objectivity and standardization. It was generally accepted that a decrease in tumor size correlated with treatment effect; as a result, imaging was adopted for lesion measurement in the World Health Organization (WHO) criteria in 1979. However, because of some limitations of the WHO criteria, the Response Evaluation Criteria in Solid Tumors (RECIST) were introduced in 2000. In RECIST, imaging was recognized as indispensable for response evaluation of solid tumors. Nevertheless, the widespread use of multidetector computed tomography and other imaging innovations have made RECIST outdated, with a concomitant need for modifications. Meanwhile, newer anticancer agents with targeted mechanisms of action have demonstrated an inherent limitation and unsuitability of anatomic tumor evaluation that assesses only lesion size. In addition, the effect of these new drugs changes the paradigm according to which tumor response or response rate is measured. Complete and partial responses cannot be the end points in all clinical trials; in some cases, disease control or progression-free survival may be the more relevant end point.

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