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Limitations of RECIST guidelines

Limitations of RECIST guidelines. Srinivasa R Prasad MD Associate Professor, Radiology University of Texas Health Science Center at San Antonio. RECIST Guidelines. R esponse E valuation C riteria I n S olid T umors Assumes spherical growth of round / ovoid tumors

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Limitations of RECIST guidelines

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  1. Limitations of RECIST guidelines Srinivasa R Prasad MD Associate Professor, Radiology University of Texas Health Science Center at San Antonio

  2. RECIST Guidelines • Response Evaluation Criteria In Solid Tumors • Assumes spherical growth of round / ovoid tumors • Uni-dimensional measurement technique • Less cumbersome, Simple math • Arbitrary number of measurable lesions • 5/organ; 10/patient

  3. RECIST Guidelines • Target lesions: >1cm (Helical); >2cm (Non-helical) • Measurement on axial images • Increase in the threshold for classifying response as disease progression • Primary modality: CT scan

  4. Limitations of RECIST guidelines • No criteria for non-solid tumors • No toxicity criteria • Lower rate of disease progression? • Not applicable to Non-Cytotoxic drugs?

  5. Change in Tumor Form: From Solid to Non-Solid

  6. Limitations of RECIST guidelines • Tumor morphology • Confluent, Irregular borders • Unusual configuration; Circumferential (eg. mesothelioma) • Lesion length > 1.5-2 times lesion width • Discordant results due to RECIST technique • Uni-dimensional measurement • Shape changes may confound results

  7. Lesion Confluence and Relationship to Normal Anatomical Structures

  8. Unusual Lesion Configuration

  9. Lesion Morphology: Mesothelioma

  10. Limitations of RECIST guidelines • Non-spherical, asymmetric tumor growth • Tumor size: Sub-centimeter tumors • Choosing representative tumor burden • Problematic when tumor burden is substantial • Differential tumor response

  11. Differential tumor behavior Pre Post

  12. Limitations of RECIST guidelines • Discordant results due to RECIST technique • Unusual Tumor morphology • Confluent tumors, Unusual growth pattern • Lesion length > 2 times lesion width • Lesions with irregular / infiltrative borders • Unpredictable Tumor Behavior • Differential tumor shrinkage/growth

  13. Differential tumor behavior

  14. Change in Tumor Form: From Solid to Non-Solid

  15. Limitations of RECIST guidelines • Updated imaging technology not considered • Multiplanar capability • Automated tumor detection • 3-D data acquisition: volumetric tumor measurement

  16. Limitations of RECIST guidelines • Criteria for tumors treated by Non-drugs? (eg: Radio-frequency ablation) • Metabolic and physiological changes predate tumor size change

  17. Non-Drug treatment of tumors: Response criteria?

  18. Imaging Pitfalls: Scanning & Visualization Techniques

  19. Future? WHO-Bidimensional RECIST-Unidimensional Volumetric

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