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

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

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