Treatment response assessment and response guided adaptive treatment
Jing Cai, Joe Y. Chang, Fang-Fang Yin in Principles and Practice of Image-Guided Radiation Therapy of Lung Cancer, 2017
Response Evaluation Criteria In Solid Tumors (RECIST) were developed in 2000 (RECIST 1.0) [1] and updated in 2009 (RECIST 1.1) to facilitate imaging response assessment [2]. RECIST 1.1 has been widely adapted and represents the current standard for assessment of tumor response using CT or anatomic magnetic resonance imaging (MRI) data. Target lesions (up to two per organ and five total [2]) are identified and the sum of the longest diameter (LD) of each target lesion is recorded. A complete response (CR) is defined as the disappearance of all target lesions, a partial response (PR) as at least a 30% decrease in the sum of the LD of target lesions, progressive disease (PD) as at least a 20% increase in the sum of the LD of target lesions or the appearance of new lesions, and stable disease (SD) as all other scenarios. There are several important changes between RECIST 1.0 and RECIST 1.1 (Table 16.1). Previously, RECIST 1.0 required documenting up to 10 target lesions (5 per organ)—now only 5 lesions (2 per organ) are required. RECIST 1.1 now includes size criteria for lymph nodes. Lymph nodes less than 10 mm short-axis diameter are being considered non-pathological, between 10 and 15 mm they are being considered a non-target lesion, and equal to or greater than 15 mm short axis is considered a target lesion. There now also is a minimum absolute increase of 5 mm in lesions in addition to the 20% increase requirement to call progressive disease (PD). Additionally, PET is now included in RECIST 1.1.
Current Role of Focal Therapy for Prostate Cancer
Ayman El-Baz, Gyan Pareek, Jasjit S. Suri in Prostate Cancer Imaging, 2018
From a technical standpoint, it seems reasonable that a patient with a unifocal clinically significant lesion (or at least disease restricted to one lobe) is better suited for focal therapy compared to those with multifocal or bilateral disease. Furthermore, the target lesion should be readily identifiable and spatially localizable using the radiographic modality guiding focal therapy delivery (i.e., ultrasound, CT, or MRI). Beyond this, the optimal selection criteria with respect to patient and disease characteristics remain poorly defined in literature. Thus far, the vast majority of patients included in clinical trials are in the low- to intermediate-risk categories, with some studies including high-risk patients as well (Table 6.2). Given that low- and intermediate-risk patients are at greater risk of “overtreatment” and exposure to morbidities associated with radical therapy, it stands to reason that these patients may gain the most from alternatives such as focal therapy.
Targeted Molecular Radiotherapy – Clinical Considerations and Dosimetry*
W. P. M. Mayles, A. E. Nahum, J.-C. Rosenwald in Handbook of Radiotherapy Physics, 2021
The absorbed dose delivered to tumours is calculated as for normal organ dosimetry. However, in this case, the self-dose far exceeds that emanating from other organs, so that geometries of source/target configurations are not relevant. However, as there is no reliable concept of a reference tumour, it is necessary to delineate any target lesion, which can be challenging in scintigraphic imaging. Outlining is frequently performed on anatomical radiological scans (computed tomography [CT], magnetic resonance imaging [MRI]), and the outlines are transferred to the corresponding regions from a single photon emission computed tomography (SPECT) or positron emission tomography (PET) scan (a process made easier with the advent of hybrid imaging). S-values are commonly determined under the assumption of spherical geometry.
Feasibility of genomic profiling with next-generation sequencing using specimens obtained by image-guided percutaneous needle biopsy
Published in Upsala Journal of Medical Sciences, 2019
Miyuki Sone, Yasuaki Arai, Shunsuke Sugawara, Takatoshi Kubo, Chihiro Itou, Tetsuya Hasegawa, Noriyuki Umakoshi, Noboru Yamamoto, Kumiko Sunami, Nobuyoshi Hiraoka, Takashi Kubo
The characteristics of the target lesions are shown in Table 3. The liver was the most common site (41.7%). The median diameter (largest length in the axial sections) of the target lesion was 35 mm, and 19 lesions (39.6%) were smaller than 30 mm. For the guiding image, US was used in 26 patients (54.2%) and angio-CT in 22 patients (45.8%). All biopsies were performed with 18-G needles with a throw length of 2 cm. Automatic biopsy needles (MUGNUM, Bard Biopsy Systems, Tempe, AZ, USA; Pro-Mag Ultra, ARGON Medical Devices, Plano, TX, USA) were used in 29 patients (60.4%) and semiautomatic biopsy needles (Temno Evolution, BD, Franklin Lakes, NY, USA; Bard Mission, Bard Biopsy Systems, Tempe, AZ, USA) in 19 patients (39.6%). The co-axial technique was used in 25 biopsies (52.1%). The median number of cores was 3 (range, 1–5). Biopsies were technically successful in all patients (100%), and the median procedure time was 20 min (range, 10–50 min).
The Current State of Cervical Endoscopic Spine Surgery: an Updated Literature Review and Technical Considerations
Published in Expert Review of Medical Devices, 2020
Yong Ahn
The endoscopic surgery in the lumbar spine is now accepted as a practical alternative among spine societies. However, the development of endoscopic surgery for the degenerative cervical spine disease is relatively slower, and RCTs on this topic are relatively rare. Therefore, cervical endoscopic surgery is still regarded as an innovative procedure and an exclusive property of some specialists. First, the most peculiar difference is the way of approach. In the lumbar spine, posterolateral transforaminal and posterior interlaminar approaches are the most popular procedures. The procedures can be performed under local anesthesia and can be classified under outpatient surgery. In contrast, the cervical endoscopic approach can be conducted anterior or posterior cervical procedures for cervical lesions, frequently compressing the spinal cord. Therefore, the process under local anesthesia or outpatient surgery is not easy. Second, the target lesion is quite different. Endoscopic procedures for the lumbar spine mainly target the soft disc disease or hypertrophied ligamentous structures compressing the nerve roots. In contrast, cervical endoscopic surgery should treat the CDH or stenosis threaten the spinal cord as the central nervous system. Finally, the endoscopic access window for the cervical spine is relatively smaller than the lumbar spine. The lumbar foraminal or interlaminar window is usually large enough that the working sheath can be passed through the window into the pathology. In contrast, the cervical anterior or posterior surgical window is relatively small and limited for the working sheath passing.
Exploratory analysis of tumor imaging in a Phase 2 trial with cabozantinib in gastrointestinal stromal tumor: lessons learned from study EORTC STBSG 1317 ‘CaboGIST’
Published in Acta Oncologica, 2022
Anastasios Kyriazoglou, Pieter Jespers, Vincent Vandecavaye, Olivier Mir, Bernd Kasper, Zsuzsanna Papai, Jean-Yves Blay, Antoine Italiano, Facundo Zaffaroni, Saskia Litière, Axelle Nzokirantevye, Patrick Schöffski
Our data indicate differences between local and central RECIST version 1.1 assessment, which is often observed in clinical trials which include both evaluations. We found a 37% discrepancy between local and central RECIST version 1.1 assessment in this GIST trial. The central reviewer upgraded the response to cabozantinib by identifying only 6 patients with PD as the best response at weeks 6/12 of treatment, compared to 13 progressing patients with local assessment. Evaluable patients who showed clinical benefit (SD + PR + CR) at week 12 were 70% using the local and 86% with central analysis, supporting the final conclusion of the CaboGIST trial that cabozantinb is an active agent in patients progressing on imatinib and sunitinib. The reasons of the discrepancies described are difficult to be explained. As mentioned above, the variability in the selection of target lesions between local and central investigators might be a critical factor. In our analysis, the central investigator was not aware of the target lesions used for local assessment. This highlights the complexity of imaging assessment especially in patients with many lesions. Further, it should be mentioned that the clinical assessment of a patient from the local investigators may be a factor of bias in the evaluation of target lesion measurements. However, the analysis performed did not reveal any obvious reasons for this discrepancy.
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