High-Grade Soft-Tissue Sarcomas: Tumor Response Assessment—Pilot Study to Assess the Correlation between Radiologic and Pathologic Response by Using RECIST and Choi Criteria

Stacchiotti, Silvia; Collini, Paola; Messina, A.; Morosi, Carlo; Barisella, Marta; Bertulli, Rossella; Piovesan, C.; Dileo, Palma; Torri, Valter; Gronchi, Alessandro; Casali, Paolo G.

doi:10.1148/radiol.2512081403

Cited by 205 publications

(156 citation statements)

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“…A pilot study in soft tissue sarcoma showed that the Choi criteria were superior to RECIST in assessing treatment response of soft tissue sarcoma treated with chemotherapy and radiotherapy. 7 In this study, we compare RECIST, Choi and "modified" Choi response criteria in which changes in both size and density of target lesions are required to define a response in RCC patients treated with the multi-targeted tyrosine kinase inhibitors sunitinib or cediranib, and their effect on time to progression and survival.…”

Section: Discussionmentioning

confidence: 99%

CT response assessment combining reduction in both size and arterial phase density correlates with time to progression in metastatic renal cancer patients treated with targeted therapies

Nathan¹,

Vinayan²,

Stott³

et al. 2010

Cancer Biology & Therapy

104

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Original article can be found at: http://www.landesbioscience.com/journals/cbt/ Copyright Landes Bioscience [Full text of this article is not available in the UHRA]Background: Response assessment is critical in evaluating effectiveness of anticancer treatment. Tyrosine kinase inhibitors (TKIs) in renal cell carcinoma (RCC) are associated with significant clinical benefit but may not result in significant tumour size reduction. Thus standard size-based response assessment with RECIST is insensitive, resulting in low response rates which do not reflect disease control measured by time to progression. We compared the use of combined size and density response criteria with standard size based criteria in metastatic RCC patients treated with TKI's. Patients and methods: CT scans from 32 patients with metastatic RCC treated with either sunitinib (18) or cediranib (14) were assessed. 12 patients were excluded from the analysis as 10 had non-contrast enhanced scans due to renal impairment and 2 stopped treatment due to toxicity. Scans from 20 evaluable patients at baseline and 12 weeks on treatment were assessed using RECIST, Choi, and modified criteria in which both a 10% decrease in size and 15% decrease in density were required to define a partial response (PR). Response assessment performed using each of the three methods was compared with time to disease progression (TTP) defined by RECIST using Kaplan-Meier statistics and Log-rank test with significance at 5%. Results: Partial response (PR) and stable disease (SD) defined by modified criteria successfully identified patients with a long TTP (448 days) or short TTP (89 days) respectively (p=0.002). Neither RECIST nor standard Choi criteria successfully discriminated between patients having a short or long clinical benefit. Conclusion: A combined reduction in both size and arterial phase density of RCC metastases treated with TKIs correlates with TTP. RECIST and standard Choi criteria appear inferior

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Section: Discussionmentioning

confidence: 99%

CT response assessment combining reduction in both size and arterial phase density correlates with time to progression in metastatic renal cancer patients treated with targeted therapies

Nathan¹,

Vinayan²,

Stott³

et al. 2010

Cancer Biology & Therapy

104

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“…29 In this retrospective analysis, we included all patients who entered the study with measurable disease and completed the study protocol treatment; these patients were evaluated before and after treatment by MRI or CT. The current study was conducted on a total of 256 patients, including 143 patients who received neoadjuvant chemotherapy and radiotherapy and 113 patients who received neoadjuvant chemotherapy and adjuvant radiotherapy.…”

Section: Methodsmentioning

confidence: 99%

“…We previously demonstrated that Choi criteria adapted to magnetic resonance imaging (MRI) correlated better with pathologic tumor response than RECIST in a series of 38 patients with high-grade soft tissue sarcomas who received preoperative chemotherapy with or without radiation therapy within a prospective phase 3 Italian Sarcoma Group/Spanish Sarcoma Group trial. 29 The results of the trial recently were reported. 30 Herein, we evaluate a comparison between RECIST and Choi criteria in eligible patients and correlate response to overall survival (OS) and freedom from progression (FFP).…”

Section: Introductionmentioning

confidence: 99%

Tumor response assessment by modified Choi criteria in localized high‐risk soft tissue sarcoma treated with chemotherapy

Stacchiotti

Verderio²,

Messina

et al. 2012

Cancer

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BACKGROUND. The objective of this study was to compare the prognostic relevance of Response Evaluation Criteria in Solid Tumors (RECIST) versus Choi criteria for the assessment of response in patients with high-risk soft tissue sarcoma of the extremities or trunk wall who received preoperative chemotherapy with or without radiotherapy in a phase 3 trial. METHODS. Patients received 3 cycles of preoperative epirubicin þ ifosfamide with or without radiotherapy. The diagnostic concordance between RECIST and Choi criteria and their correlation with overall survival (OS) and freedom from progression (FFP) were evaluated in a univariate Cox regression model. RESULTS. In 243 of 321 eligible patients, RECIST, Choi criteria, and histology were predictive for OS and FFP. In the subgroup of 69 patients who received chemotherapy alone and were evaluable by both RECIST and Choi criteria, Choi criteria were associated significantly with OS and FFP, whereas RECIST predicted only FFP, and the pattern of agreement observed between the 2 criteria was unsatisfactory. On a dichotomous scale, comparing objective response (complete and partial responses) and lack of response (stable and progressive disease) to preoperative chemotherapy according to RECIST and Choi criteria, only Choi criteria were predictive of OS and FFP, and fair agreement between RECIST and Choi criteria was observed. When lack of progression and progression were compared (complete and partial responses þ stable disease vs progressive disease), both assessment criteria were significantly predictive of OS and FFP, and there was substantial agreement between the 2 criteria. CONCLUSIONS. Response to chemotherapy with or without radiotherapy was associated with a better outcome in patients with high-risk soft tissue sarcoma. Choi criteria were better predictors than RECIST in patients who received preoperative chemotherapy alone. Cancer 2012;118:5857-66.

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“…20) and the Choi criteria, as recently defined for gastrointestinal stromal tumor (GIST; ref. 21) and adapted to MRI (22), and PET response, in case of positive PET at baseline.…”

Section: Clinical Methods and Treatmentmentioning

confidence: 99%

Sunitinib Malate and Figitumumab in Solitary Fibrous Tumor: Patterns and Molecular Bases of Tumor Response

Stacchiotti

Negri

Palassini

et al. 2010

Molecular Cancer Therapeutics

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Antiangiogenic treatment activity has been reported in solitary fibrous tumor (SFT), a rare and little chemosensitive sarcoma. We explored the activity of sunitinib malate (SM) in SFT and studied receptor tyrosine kinase (RTK) activation profile. Eleven patients with progressive metastatic SFT resistant to chemotherapy were treated with continuous-dosing 37.5 mg/d SM on a named-use basis. One of them also received the insulin-like growth factor I receptor (IGFIR) inhibitor figitumumab after developing secondary resistance to SM. Besides, biochemical, molecular, and fluorescence in situ hybridization analyses were done in eight naïve SFTs whose cryopreserved material was available to clarify RTK upstream and downstream signaling. In two cases treated with SM and belonging to the naïve series, both pretreatment and posttreatment samples were available. Ten patients were evaluable for response to SM. The best response according to the Choi criteria was six partial response (all with Response Evaluation Criteria in Solid Tumors stable disease), one stable disease, and three progressive disease. Responses lasted >6 months in five patients. The eight naïve samples showed high expression/phosphorylation of PDGFRB, epidermal growth factor receptor, and IGFIR/IR, in the presence of their cognate ligands. Downstream pathways revealed expression/activation of Akt, extracellular signal-regulated kinase 1-2 and, closely related to SFT subtypes, of S6 and 4E-BP1. In two patients, whose pretreatment and posttreatment clinical and molecular status were available, biochemical data confirmed the activity of SM, although they also suggested a possible time-dependent shift of dominant RTK from PDGFRB to IGFIR/insulin receptor. A Response Evaluation Criteria in Solid Tumors partial response to figitumumab corroborated these findings. SM has antitumor activity in SFT, possibly through a PDGFRB-mediated mechanism, but treatments with IGFIR/ insulin receptor and possibly epidermal growth factor receptor inhibitors are worth testing. Mol Cancer Ther; 9(5); 1286-97. ©2010 AACR.

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High-Grade Soft-Tissue Sarcomas: Tumor Response Assessment—Pilot Study to Assess the Correlation between Radiologic and Pathologic Response by Using RECIST and Choi Criteria

Abstract: In STS treated with chemotherapy and radiation therapy, tumor size may be insufficient to render actual tumor response. Tumor attenuation at CT or tumor contrast material enhancement at MR imaging may complement tumor size, thus making Choi criteria more predictive of pathologic response.

Cited by 205 publications

References 34 publications

CT response assessment combining reduction in both size and arterial phase density correlates with time to progression in metastatic renal cancer patients treated with targeted therapies

CT response assessment combining reduction in both size and arterial phase density correlates with time to progression in metastatic renal cancer patients treated with targeted therapies

Tumor response assessment by modified Choi criteria in localized high‐risk soft tissue sarcoma treated with chemotherapy

Sunitinib Malate and Figitumumab in Solitary Fibrous Tumor: Patterns and Molecular Bases of Tumor Response

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