Løitegård Terje, Berntzen Dag T, Thiis-Evensen Espen
Department of Gastroenterology, Oslo University Hospital, Rikshospitalet, Sognsvannsveien 20, 0424, Oslo, Norway.
Department of Radiology, Oslo University Hospital, Rikshospitalet, Oslo, Norway.
Ann Nucl Med. 2019 Mar;33(3):147-152. doi: 10.1007/s12149-018-1316-2. Epub 2018 Nov 7.
The Response Evaluation Criteria In Solid Tumors (RECIST) is the most used radiological method for evaluating response after peptide receptor radionuclide therapy (PRRT) in patients with neuroendocrine tumors. This method may give too positive estimates of response in slow growing tumors as it allows a substantial increase in tumor size before patients are classified as having progressive disease. We wanted to compare RECIST with a conventional method in routine use for estimating treatment effect based on defining any unequivocal increase in size of tumor load as progressive disease. We also wanted to investigate whether any differences had clinical implications.
Patients treated with Lutetium-DOTA-octreotate having at least one follow-up radiological response evaluation were included. Radiological examinations were retrospectively evaluated by RECIST and compared to the radiological evaluations performed at regular follow-up examinations.
Seventy-nine patients were included, 33 (42%) were women, median age 65 years. The primary tumors was located in the small intestine in 35 (44%) and the in the pancreas in 27 (34%) of the patients. Indication for treatment was progressive disease in 71 (90%) patients. Based on RECIST, 67 (85%) patients had objective response or stable disease as best effect versus 59 (75%) patients based on the conventional method (p < 0.001). Median progression free survival was 33 months estimated by RECIST and 28 months estimated with the conventional method (p < 0.001). Eight (10%) patients received tumor-targeted therapy due to progressive disease based on the conventional method while still having stable disease according to RECIST.
Response evaluation after PRRT with RECIST gave more positive estimates for treatment effects compared to a method where any equivocal change in tumor load was regarded as significant. These differences had clinical implications.
实体瘤疗效评价标准（RECIST）是评估神经内分泌肿瘤患者接受肽受体放射性核素治疗（PRRT）后疗效最常用的影像学方法。该方法对于生长缓慢的肿瘤可能会给出过于乐观的疗效评估，因为在患者被归类为疾病进展之前，它允许肿瘤大小有大幅增加。我们希望将RECIST与常规使用的一种方法进行比较，该常规方法基于将肿瘤负荷大小的任何明确增加定义为疾病进展来评估治疗效果。我们还想研究是否存在任何具有临床意义的差异。
纳入接受镥 - DOTA - 奥曲肽治疗且至少有一次随访影像学疗效评估的患者。通过RECIST对影像学检查进行回顾性评估，并与定期随访检查时进行的影像学评估进行比较。
纳入79例患者，33例（42%）为女性，中位年龄65岁。35例（44%）患者的原发肿瘤位于小肠，27例（34%）位于胰腺。71例（90%）患者的治疗指征为疾病进展。基于RECIST，67例（85%）患者的最佳疗效为客观缓解或疾病稳定，而基于常规方法为59例（75%）患者（p < 0.001）。根据RECIST估计的无进展生存期中位数为33个月，用常规方法估计为28个月（p < 0.001）。8例（10%）患者因基于常规方法的疾病进展而接受了肿瘤靶向治疗，而根据RECIST他们仍处于疾病稳定状态。
与将肿瘤负荷的任何不明确变化视为显著变化的方法相比，PRRT后采用RECIST进行疗效评估对治疗效果的估计更为乐观。这些差异具有临床意义。
