生长转移阈值降低：体绘制的机会及其对治疗决策的影响。
Reduction in growth threshold for pulmonary metastases: an opportunity for volumetry and its impact on treatment decisions.
机构信息
Department of Diagnostic and Interventional Radiology, Eberhard-Karls-University, Tübingen, Germany.
出版信息
Br J Radiol. 2012 Jul;85(1015):959-64. doi: 10.1259/bjr/87835487.
OBJECTIVES
This study compares tumour response assessment by automated CT volumetry and standard manual measurements regarding the impact on treatment decisions and patient outcome.
METHODS
58 consecutive patients with 203 pulmonary metastases undergoing baseline and follow-up multirow detector CT (MDCT) under chemotherapy were assessed for response to chemotherapy. Tumour burden of pulmonary target lesions was quantified in three ways: (1) following response evaluation criteria in solid tumours (RECIST); (2) following the volume equivalents of RECIST (i.e. with a threshold of -65/+73%); and (3) using calculated limits for stable disease (SD). For volumetry, calculated limits had been set at ±38% prior to the study by repeated quantification of nodules scanned twice. Results were compared using non-weighted κ-values and were evaluated for their impact on treatment decisions and patient outcome.
RESULTS
In 15 (17%) of the 58 patients, the results of response assessment were inconsistent with 1 of the 3 methods, which would have had an impact on treatment decisions in 8 (13%). Patient outcome regarding therapy response could be verified in 5 (33%) of the 15 patients with inconsistent measurement results and was consistent with both RECIST and volumetry in 1, with calculated limits in 3 and with none in 1. Diagnosis as to the overall response was consistent with RECIST in six patients, with volumetry in six and with calculated limits in eight cases. There is an impact of different methods for therapy response assessment on treatment decisions.
CONCLUSION
A reduction of threshold for SD to ±30-40% of volume change seems reasonable when using volumetry.
目的
本研究比较了自动 CT 体绘制和标准手动测量在治疗决策和患者预后方面对肿瘤反应评估的影响。
方法
58 例 203 个肺转移患者在化疗下行基线和随访多层探测器 CT（MDCT），评估化疗后的肿瘤反应。采用三种方法对肺靶病变的肿瘤负荷进行定量评估：（1）采用实体瘤反应评估标准（RECIST）；（2）采用 RECIST 的体积等效物（即阈值为-65/+73%）；（3）采用计算的稳定疾病（SD）界限。在研究之前，通过对扫描两次的结节进行重复定量，为体绘制计算了±38%的界限。使用非加权κ值比较结果，并评估其对治疗决策和患者预后的影响。
结果
在 58 例患者中，有 15 例（17%）的反应评估结果与 3 种方法中的 1 种不一致，这将影响 8 例（13%）的治疗决策。在 15 例测量结果不一致的患者中，有 5 例（33%）的治疗反应可通过患者的治疗结果得到验证，其中 1 例与 RECIST 和体绘制一致，3 例与计算界限一致，1 例无反应。6 例患者的总体反应诊断与 RECIST 一致，6 例与体绘制一致，8 例与计算界限一致。不同的治疗反应评估方法对治疗决策有影响。
结论
当使用体绘制时，将 SD 的阈值降低到体积变化的±30-40%似乎是合理的。
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