Background
RECIST (Response Evaluation Criteria in Solid Tumors) is the accepted method for determining tumor progression. However, RECIST may not accurately estimate disease burden because the axial plane often does not produce the actual longest diameter. Volumetric measurements may be an alternative to better determine tumor size. Our aim was to compare volumetric measurements with RECIST in pancreatic ductal adenocarcinomas (PDA) and hepatocellular carcinomas (HCC).
Methods
RECIST and volumetric measurements were determined in 9 patients with metastatic PDA and 17 patients with HCC who subsequently underwent liver transplantation. Gross pathological measurements after hepatectomy were also analyzed for volumes.
Results
3-D diameter in volumetric analysis was 38% and 36% higher than RECIST diameter in PDA and HCC, respectively (p < 0.01). However, RECIST yielded 78% and 23% larger estimated tumor volumes than volumetric analysis in PDA and HCC respectively (p < 0.01). Gross pathological volume in HCC demonstrated a linear correlation with both volumetric analysis (r = 0.95, p < 0.01) and RECIST (r = 0.96, p < 0.01) but RECIST significantly overestimated gross pathological volume by an average of 28% (p < 0.01) while volumetric analysis was similar to gross pathological volume (p = 0.56). In categorizing treatment response in PDA, RECIST and volumetric analysis were in “moderate agreement” (κ = 0.49).
Conclusions
RECIST may significantly overestimate tumor burden compared to volumetric measurements in both PDA and HCC. Volumetric analysis may be the preferred method to detect tumor progression.