limitations of recist guidelines srinivasa r prasad md associate professor, radiology university of...
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Limitations of RECIST guidelinesLimitations of RECIST guidelines
Srinivasa R Prasad MDSrinivasa R Prasad MDAssociate Professor, RadiologyAssociate Professor, Radiology
University of Texas Health Science Center at University of Texas Health Science Center at San AntonioSan Antonio
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RECIST GuidelinesRECIST Guidelines
• Response Evaluation Criteria In Solid Tumors
• Assumes spherical growth of round / ovoid tumors
• Uni-dimensional measurement technique– Less cumbersome, Simple math
• Arbitrary number of measurable lesions– 5/organ; 10/patient
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• Target lesions: >1cm (Helical); >2cm (Non-helical)
• Measurement on axial images
• Increase in the threshold for classifying response as disease progression
• Primary modality: CT scan
RECIST GuidelinesRECIST Guidelines
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Limitations of RECIST guidelinesLimitations of RECIST guidelines
• No criteria for non-solid tumors • No toxicity criteria• Lower rate of disease progression?• Not applicable to Non-Cytotoxic drugs?
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Change in Tumor Form: Change in Tumor Form: From Solid to Non-SolidFrom Solid to Non-Solid
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• Tumor morphology– Confluent, Irregular borders– Unusual configuration; Circumferential (eg.
mesothelioma)– Lesion length > 1.5-2 times lesion width
• Discordant results due to RECIST technique– Uni-dimensional measurement– Shape changes may confound results
Limitations of RECIST guidelinesLimitations of RECIST guidelines
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Lesion Confluence and Lesion Confluence and Relationship to Normal Relationship to Normal Anatomical StructuresAnatomical Structures
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Unusual Lesion Unusual Lesion ConfigurationConfiguration
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Lesion Morphology: Mesothelioma
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• Non-spherical, asymmetric tumor growth
• Tumor size: Sub-centimeter tumors
• Choosing representative tumor burden– Problematic when tumor burden is substantial
– Differential tumor response
Limitations of RECIST guidelinesLimitations of RECIST guidelines
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Differential tumor Differential tumor behaviorbehavior
Pre
Post
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• Discordant results due to RECIST technique– Unusual Tumor morphology
• Confluent tumors, Unusual growth pattern
• Lesion length > 2 times lesion width
• Lesions with irregular / infiltrative borders
– Unpredictable Tumor Behavior
• Differential tumor shrinkage/growth
Limitations of RECIST guidelines
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Differential tumor behavior
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Change in Tumor Change in Tumor Form: From Form: From Solid to Non-SolidSolid to Non-Solid
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• Updated imaging technology not considered
– Multiplanar capability
– Automated tumor detection
– 3-D data acquisition: volumetric tumor measurement
Limitations of RECIST guidelinesLimitations of RECIST guidelines
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• Criteria for tumors treated by Non-drugs? (eg: Radio-frequency ablation)
• Metabolic and physiological changes predate tumor size change
Limitations of RECIST guidelinesLimitations of RECIST guidelines
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Non-Drug treatment of tumors: Response criteria?Non-Drug treatment of tumors: Response criteria?
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Imaging Pitfalls: Scanning & Visualization Techniques
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Future?Future?
WHO-Bidimensional
RECIST-Unidimensional
Volumetric