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Modified Recist Criteria:Applications in Clinical
Practice
DENNIS FOLEY
MEDICAL COLLEGE WISCONSIN
Response Evaluation Criteria in Solid Tumors ( RECIST )
Year 2000 GOAL STANDARDISE AND SIMPLIFY
TUMOR RESPONSE CRITERIA
MAJOR APPLICATION ONCOLOGIC CLINICAL TRIALS
INVOLVING MULTIFOCAL SOLID TUMORS
WHO vs. RECIST Criteria WHO (2 dimensions) :
Single lesion: multiply the longest diameter by the greatest perpendicular diameter
Multiple lesions: sum the products of all measured lesions
RECIST (1 dimension): Single lesion: longest diameter of target lesion
Multiple lesions: sum of diameters of all targets
Response WHO RECIST
Complete Response Disappearance of all lesions
Partial Response >50% decrease >30% decrease
Stable Ds Neither PR or PD Neither PR or PD
Progression > 25% increase > 20% increase
METASTATIC UROTHELIAL CANCER
Recist 1.1 Criteria (1)Year 2009
MEASURABLE LESIONS 2 PER ORGAN, MAXIMUM 5
LYMPH NODE DISEASE SHORT AXIS DIMENSION >15 MM <10 MM ( NON MEASURABLE ) 10-15 MM ( NON TARGET )
DISEASE PROGRESSION 20% INCREASE IN SUM OF THE TARGET
LESIONS
Recist 1.1 (3)Additional Issues
TUMOR NECROSIS, LIQUEFACTION, HEMORRHAGE TUMOR DIMENSIONS STABLE OR ENLARGED
CAVITATION
PROGRESSION OF NON TARGET LESIONS
METABOLIC RESPONSE ( CT PET )
Nishino et al: AJR 2010; 195;281-289
METASTATIC GASTRIC GASTRO INTESTINAL STROMAL TUMOR
MULTIPHASE HEPATIC CT
0 4515 30 60 755 cc/sec 30 secs
EARLY ARTERIAL PHASELATE ARTERIAL PHASEPORTAL VENOUS PHASE
EARLY ARTERIAL
LATE ARTERIAL/ PVIF
HEPATIC
CIRRHOSIS HEP B POS HEPATOCELLULAR CA THAD
ARTERIO PORTAL FISTULA
HEPATOCELLULAR CARCINOMA
LATE ARTERIAL PHASE
HEPATIC PHASE
1 YEAR FOLLOW UPLATE ARTERIAL PHASE
HEPATIC PHASE
AASLD/EASL criteria for HCC
Size Characteristics c/w HCC Further workup of equivocal lesions
> 2 cm (1) Arterial enhancement with venous washout or
(2) AFP >200 ng/mL
Biopsy
1-2 cm (1) dynamic studies (CT or MRI) demonstrating characteristic enhancement
Biopsy
< 1cm Arterial enhancement may not correspond to HCC
Surveillance imaging
Reporting of indeterminate lesions
< 1 cm
1‐2 cm
Modified RECIST
WHO and RECIST criteria do not accurately assess anti-tumor therapies which do not result in tumor shrinkage
mRECIST recommended by AASLD
Response WHO RECIST mRECIST
Complete Response Disappearance of all lesions Disappearance of intratumoral arterial
enhancementPartial Response >50% decrease >30% decrease >30% decrease in
viable target lesionsStable Ds Neither PR or PD Neither PR or PD Neither PR or PD
Progression > 25% increase > 20% increase >20% increase in viable target lesions
Reporting of Post-Treatment Response
Longest Overall TumorDiameter
Longest Viable Tumor Diameter
Modified Recist Target Lesions
RECIST MEASURABLE ACCURATLY MEASURED IN ONE
DIMENSION AS AT LEAST 1 CM
SUITABLE FOR REPEAT MEASUREMENT
LESION DEMONSTRATES INTRA TUMORAL ARTERIAL ENHANCEMENT ON CONTRAST ENHANCED CT OR MRI
HCC : PRE , POST SELECTIVE ARTERIAL THERAPY WITH DEB
IMMEDIATE POST RX
3 MONTH SURVEILLANCE
SERIAL SURVEILLANCE
Modified Recist Non Target Lesions
RECIST NON MEASURABLE INFILTRATIVE LESIONS WITH ILL
DEFINED BORDERS
PREVIOUSLY TREATED BY LOCOREGIONAL OR SYSTEMIC THERAPY WITH MULTIFOCAL AREAS OF NECROSIS
HCC POST ABLATION
HCC PRE / POST TACE
HCC TACE VIABLE TUMOR
PRE CONTRAST
LATE ARTERIAL PHASE
HEPATIC PHASE
HCC SPONTANEOUS HEMORRHAGE
INFILTRATIVE HCC
INFILTRATIVE HCC TUMOR THROMUS
PULMONARY METASTASIS
Summary
RECIST CRITERIA DEVELOPED FOR USE IN ONCOLOGY CLINICAL TRIALS
RECOGNITION OF TARGET AND NON TARGET LESIONS AND ACCURATE MEASUREMENTS OF TARGET LESIONS ON SERIAL STUDIES ARE BENCHMARKS IN ASSESSING TUMOR RESPONSE
MANY VARIABLES APART FROM TUMOR DIMENSIONS THAT REFLECT RESPONSE