Radiological Monitoring of the Treatment of Solid Tumors in Practice

Abstract

Purpose: Thanks to advances in cancer therapy, the diagnosis of “incurable cancer” is increasingly able to be changed to a chronic disease that is manageable over long periods, resulting in a change in the clinical management of cancer patients with solid tumors. New parameters are needed to measure the success of targeted therapy in clinical trials.

Materials and Methods: Review article on the basis of selective literature research.

Results: In order to assess how well solid tumors respond to treatment, size-based criteria called RECIST (Response Evaluation Criteria in Solid tumors) have been defined. These criteria have been validated in large oncology trials and are currently used most frequently. New molecular therapies often do not – or at least do not immediately – reduce the size of a tumor. Therefore, RECIST evaluation should be critically assessed especially in the case of modern therapies. Any additional available tumor biology information should be considered. In radiology new methods and developments of RECIST have been introduced to better assess the success of targeted therapy.

Conclusion: Assessment according to RECIST has been proven for the follow-up of classic tumor therapy. For the monitoring of targeted therapies, new parameters are often required. Therefore, some specific tumor- and therapy-adapted criteria have already been defined to better evaluate treatment success in clinical trials.

Key points:

• Follow-up evaluation of treatment is becoming increasingly important in modern oncology.

• Conventional cytostatic/cytotoxic treatments can be evaluated on the basis of size according to RECIST.

• However, approx. 80 % of newly approved oncological agents are based on molecular mechanisms of action.

• In the case of molecular treatment forms, the tumor volume does not necessarily correlate with the course of the disease.

• Therefore, there are new practice-relevant treatment-adapted and tumor-adapted imaging methods.

Citation Format:

• Ganten MK, Ganten TM, Schlemmer HP. Radiological Monitoring of the Treatment of Solid Tumors in Practice. Fortschr Röntgenstr 2014; 186: 466 – 473

Zusammenfassung

Hintergrund: Dank der großen Fortschritte in der onkologischen Therapie wird Krebs zunehmend zu einer chronischen über lange Zeiträume beherrschbaren Erkrankung. Hierdurch hat sich das klinische Management für Tumorpatienten mit soliden Tumoren verändert. Neue Parameter sind erforderlich, den Erfolg der zielgerichteten Medikamente sog. „Targeted Therapies“ in klinischen Studien zu messen.

Material und Methoden: Übersichtsarbeit auf der Basis einer selektiven Literaturaufarbeitung.

Ergebnisse: Das Therapieansprechen solider Tumoren wurde bisher anhand der Größenänderung nach RECIST (Response Evaluation Criteria In Solid Tumors) beurteilt. Diese Kriterien wurden in großen onkologischen Studien validiert und werden breit eingesetzt. Für die Verlaufskontrolle der klassischen zytostatisch/zytotoxischen Tumortherapie hat sich die Beurteilung nach RECIST bewährt. Neue molekulare Therapien bewirken jedoch häufig nicht – oder nicht sofort – eine Verkleinerung des Tumors. Daher ist die Tumorgröße alleine heute in vielen Fällen nicht mehr ausreichend zur Beurteilung des Therapieeffektes und kann zu Fehleinschätzungen führen. Gerade bei modernen Therapien ist die Beurteilung nach RECIST kritisch zu betrachten. Zusätzlich verfügbare Informationen zur Tumorbiologie sollten berücksichtigt werden. In der Radiologie werden zunehmend neue Verfahren und Weiterentwicklungen von RECIST eingeführt, um den Erfolg der „Targeted Therapy“ besser beurteilen zu können. Diese haben in vielen Fällen Praxisreife erlangt und werden hier diskutiert.

Schlussfolgerungen: Für das Monitoring zielgerichteter Therapien sind neue Parameter erforderlich und verfügbar. Schon heute sind spezifische tumor- und therapieangepasste Kriterien für klinische Studien festgelegt, um den Erfolg moderner molekularer Therapieverfahren radiologisch besser beurteilen zu können.

Key words

CT - metastases - staging

• Literatur

• 1 Nennecke A, Brenner H, Eberle A et al. Überlebenschancen von Krebspatienten in Deutschland: auf dem Weg zu repräsentativen, vergleichbaren Aussagen. Gesundheitswesen 2010; 72: 692-699
• 2 Galbraith SM. MR in oncology drug development. NMR in biomedicine 2006; 19: 681-689
• 3 Milano A, Perri F, Ciarmiello A et al. Targeted-therapy and imaging response: a new paradigm for clinical evaluation?. Rev Recent Clin Trials 2011; 6: 259-265
• 4 Romero-Camarero I, Barajas-Diego M, Castellanos-Martin A et al. New models towards assessing anti-cancer therapeutics. Histology and histopathology 2012; 27: 157-170
• 5 Siegmund-Schultze N. Onkologie: Erfolge bei metastasierten Tumoren. Dtsch Arztebl 2012; 109: 27-28
• 6 Cousin S, Taieb S, Penel N. A paradigm shift in tumour response evaluation of targeted therapy: the assessment of novel drugs in exploratory clinical trials. Current opinion in oncology 2012; 24: 338-344
• 7 Choi H. Response evaluation of gastrointestinal stromal tumors. The oncologist 2008; 13: 4-7
• 8 Lencioni R, Llovet JM. Modified RECIST (mRECIST) assessment for hepatocellular carcinoma. Seminars in liver disease 2010; 30: 52-60
• 9 Wolchok JD, Hoos A, O'Day S et al. Guidelines for the evaluation of immune therapy activity in solid tumors: immune-related response criteria. Clinical cancer research: an official journal of the American Association for Cancer Research 2009; 15: 7412-7420
• 10 Abou-Alfa GK, Schwartz L, Ricci S et al. Phase II study of sorafenib in patients with advanced hepatocellular carcinoma. J Clin Oncol 2006; 24: 4293-4300
• 11 Ganten MK, Weber MA, Ganten TM. Zelluläre Mechanismen der Tumorresponse, klinische Anforderungen. Radiologe 2008; 48: 820-831
• 12 Herzer K, Ganten TM, Schulze-Bergkamen H et al. Transforming growth factor beta can mediate apoptosis via the expression of TRAIL in human hepatoma cells. Hepatology 2005; 42: 183-192
• 13 Miller AB, Hoogstraten B, Staquet M et al. Reporting results of cancer treatment. Cancer 1981; 47: 207-214
• 14 Wen PY, Macdonald DR, Reardon DA et al. Updated response assessment criteria for high-grade gliomas: response assessment in neuro-oncology working group. J Clin Oncol 2010; 28: 1963-1972
• 15 Therasse P, Arbuck SG, Eisenhauer EA et al. New guidelines 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: 205-216
• 16 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: 228-247
• 17 Schwartz LH, Bogaerts J, Ford R et al. Evaluation of lymph nodes with RECIST 1.1. Eur J Cancer 2009; 45: 261-267
• 18 Tsuchida Y, Therasse P. Response evaluation criteria in solid tumors (RECIST): new guidelines. Medical and pediatric oncology 2001; 37: 1-3
• 19 Gebauer B, Bohnsack O, Riess H. Radiologische Evaluation des Tumoransprechens in onkologischen Therapiestudien (Tumor Response Evaluation). Fortschr Röntgenstr 2011; 183: 695-703
• 20 Karul M. RECIST ist einfach-mit RECIST zu arbeiten jedoch nicht!. Radiologe 2011; 51: 653
• 21 Wulff AM, Bolte H, Fischer S et al. Lung, liver and lymph node metastases in follow-up MSCT: comprehensive volumetric assessment of lesion size changes. Fortschr Röntgenstr 2012; 184: 820-828
• 22 Levine ZH, Pintar AL, Hagedorn JG et al. Uncertainties in RECIST as a measure of volume for lung nodules and liver tumors. Medical physics 2012; 39: 2628-2637
• 23 Buchmann I, Ganten TM, Haberkorn U. FDG-PET in der Diagnostik gastrointestinaler Tumoren. Zeitschrift fur Gastroenterologie 2008; 46: 367-375
• 24 Wahl RL, Jacene H, Kasamon Y et al. From RECIST to PERCIST: Evolving Considerations for PET response criteria in solid tumors. Journal of nuclear medicine: official publication, Society of Nuclear Medicine 2009; 50: 122S-150S
• 25 Ganten MK. Verlaufsbeurteilung des malignen Lymphoms. Radiologe 2012; 52: 330-337
• 26 Cheson BD, Pfistner B, Juweid ME et al. Revised response criteria for malignant lymphoma. J Clin Oncol 2007; 25: 579-586
• 27 Cheson BD, Horning SJ, Coiffier B et al. Report of an international workshop to standardize response criteria for non-Hodgkin's lymphomas. NCI Sponsored International Working Group. J Clin Oncol 1999; 17: 1244
• 28 Wessling J, Puesken M, Koch R et al. MSCT follow-up in malignant lymphoma: comparison of manual linear measurements with semi-automated lymph node analysis for therapy response classification. Fortschr Röntgenstr 184: 795-804
• 29 Rimassa L, Santoro A. Sorafenib therapy in advanced hepatocellular carcinoma: the SHARP trial. Expert review of anticancer therapy 2009; 9: 739-745
• 30 Kalkmann J, Zeile M, Antoch G et al. Consensus report on the radiological management of patients with gastrointestinal stromal tumours (GIST): recommendations of the German GIST Imaging Working Group. Cancer Imaging 2012; 12: 126-135
• 31 Hanahan D, Weinberg RA. The hallmarks of cancer. Cell 2000; 100: 57-70
• 32 Padhani AR, Koh DM, Collins DJ. Whole-body diffusion-weighted MR imaging in cancer: current status and research directions. Radiology 2011; 261: 700-718
• 33 Padhani AR, Miles KA. Multiparametric imaging of tumor response to therapy. Radiology 2010; 256: 348-364
• 34 Fueger BJ, Helbich TH, Schernthaner M et al. Stellenwert der multiparametrischen Magnetresonanztomographie beim Prostatakarzinom. Radiologe 2011; 51: 947-954
• 35 Padhani AR. Integrating multiparametric prostate MRI into clinical practice. Cancer Imaging 2011; 11: S27-S37
• 36 Li SP, Padhani AR. Tumor response assessments with diffusion and perfusion MRI. Journal of magnetic resonance imaging: JMRI 2012; 35: 745-763
• 37 Mangold S, Thomas C, Fenchel M et al. Virtual Nonenhanced Dual-Energy CT Urography with Tin-Filter Technology: Determinants of Detection of Urinary Calculi in the Renal Collecting System. Radiology 2012; 264: 119-125
• 38 Ratain MJ, Eckhardt SG. Phase II studies of modern drugs directed against new targets: if you are fazed, too, then resist RECIST. J Clin Oncol 2004; 22: 4442-4445