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Annals of Oncology Advance Access originally published online on April 26, 2006
Annals of Oncology 2006 17(6):1018-1023; doi:10.1093/annonc/mdl058
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© 2006 European Society for Medical Oncology

Measuring tumor response and shape change on CT: esophageal cancer as a paradigm

L. H. Schwartz1, J. A. C. Colville1, M. S. Ginsberg1, L. Wang1, M. Mazumdar2, J. Kalaigian1, H. Hricak1, D. Ilson3 and G. K. Schwartz3,*

Department of 1 Radiology, 2 Biostatistics and Epidemiology and 3 Medicine, Memorial Sloan-Kettering Cancer Center, New York, USA

* Correspondence to: Dr G. K. Schwartz, Department of Medicine, Memorial Sloan-Kettering Cancer Center, 1275 York Avenue, New York, NY 10021, USA. Tel: +212-639-5511; Fax: +212-794-4010; E-mail: schwartg{at}mskcc.org

Background: Accurate response assessment is essential for evaluating new cancer treatments. We evaluated the impact of Response Evaluation Criteria in Solid Tumors (RECIST), World Health Organization (WHO) criteria and tumor shape on response assessment in patients with metastatic esophageal cancer.

Patients and methods: In 19 patients with metastatic esophageal cancer in a phase II trial of bryostatin-1 and paclitaxel, response was retrospectively assessed for 89 lesions with RECIST and WHO criteria on baseline and serial follow-up CT scans. The eccentricity factor (EF) was introduced for measuring the degree to which tumor shape diverges from a perfect sphere [EF = {surd}1-(LPD/MD)2, where LPD is the largest perpendicular diameter and MD is the maximal diameter].

Results: The disagreement rate in best overall response categorization between RECIST (unidimensional) and WHO (bidimensional) criteria was 26.3%. Change in eccentricity was significantly greater (P < 0.01) for patients with disagreement (mean 0.31, range 0–0.91). When the short axis was used for unidimensional lymph node measurement, disagreement between WHO and RECIST lessened.

Conclusions: Response assessment by WHO and RECIST differs substantially. Greater change in eccentricity is associated with greater discordance between WHO and RECIST. The discordance between WHO and RECIST may impact on how effective a therapy is judged to be.

Key words: esophageal cancer, RECIST, response criteria, World Health Organization


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