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Tumour response interpretation with new tumour response criteria vs the World Health Organisation criteria in patients with bone-only metastatic breast cancer.

Hamaoka T, Costelloe CM, Madewell JE, Liu P, Berry DA, Islam R, Theriault RL, Hortobagyi GN, Ueno NT - Br. J. Cancer (2010)

Bottom Line: With the MDA criteria, there were significant differences in PFS between patients classified as responders and those classified as nonresponders (P=0.025), but with the WHO criteria, there were not.Application of the MDA classification may allow bone lesions to be considered measurable disease.Prospective study is needed to test the MDA classification among patients with bone metastasis.

View Article: PubMed Central - PubMed

Affiliation: Department of Stem Cell Transplantation and Cellular Therapy, The University of Texas M. D. Anderson Cancer Center, Houston, 77030, USA.

ABSTRACT

Background: We compared the utility of a new response classification (MDA; based on computed tomography (CT), magnetic resonance imaging (MRI), plain radiography (XR), and skeletal scintigraphy (SS)) and the World Health Organisation response classification (WHO; based on XR and SS) in stratifying breast cancer patients with bone-only metastases with respect to progression-free survival (PFS), overall survival (OS), and clinical response.

Methods: We retrospectively reviewed 41 patients with bone-only metastatic breast cancer and assigned responses according to the MDA and WHO criteria. We analysed whether the MDA or WHO response classifications correlated with PFS and OS.

Results: With the MDA criteria, there were significant differences in PFS between patients classified as responders and those classified as nonresponders (P=0.025), but with the WHO criteria, there were not. Neither criteria distinguished responders from nonresponders in terms of OS. MDA response criteria correlated better than WHO response criteria with clinical response assessment.

Conclusions: The MDA classification is superior to the WHO classification in differentiating between responders and nonresponders among breast cancer patients with bone-only metastases. Application of the MDA classification may allow bone lesions to be considered measurable disease. Prospective study is needed to test the MDA classification among patients with bone metastasis.

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Related in: MedlinePlus

Computed tomography scans assessed with the MDA criteria. (A) Sclerotic change (right) in the rim of an originally lytic lesion (left) indicates a partial response. (B) Lytic progression (right) of an originally lytic lesion (left) indicates progressive disease.
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fig3: Computed tomography scans assessed with the MDA criteria. (A) Sclerotic change (right) in the rim of an originally lytic lesion (left) indicates a partial response. (B) Lytic progression (right) of an originally lytic lesion (left) indicates progressive disease.

Mentions: We previously reported a new set of response criteria, the MDA criteria, that address the shortcomings of the UICC and WHO criteria by taking into account CT and MRI findings (Hamaoka et al, 2004) (Table 1). The MDA criteria also include detailed descriptions of anatomic changes to be considered for each diagnostic imaging modality. The MDA criteria take into account the fact that the structure of bone rarely heals such that the bone has the same appearance as the original even if treatment was significantly effective (complete response). For example, according to the MDA criteria, recalcification of the rim of an osteolytic lesion on XR or CT (Figure 3A) is considered partial response, and an increase in the area of lysis (Figure 3B) is considered progressive disease.


Tumour response interpretation with new tumour response criteria vs the World Health Organisation criteria in patients with bone-only metastatic breast cancer.

Hamaoka T, Costelloe CM, Madewell JE, Liu P, Berry DA, Islam R, Theriault RL, Hortobagyi GN, Ueno NT - Br. J. Cancer (2010)

Computed tomography scans assessed with the MDA criteria. (A) Sclerotic change (right) in the rim of an originally lytic lesion (left) indicates a partial response. (B) Lytic progression (right) of an originally lytic lesion (left) indicates progressive disease.
© Copyright Policy
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC2837571&req=5

fig3: Computed tomography scans assessed with the MDA criteria. (A) Sclerotic change (right) in the rim of an originally lytic lesion (left) indicates a partial response. (B) Lytic progression (right) of an originally lytic lesion (left) indicates progressive disease.
Mentions: We previously reported a new set of response criteria, the MDA criteria, that address the shortcomings of the UICC and WHO criteria by taking into account CT and MRI findings (Hamaoka et al, 2004) (Table 1). The MDA criteria also include detailed descriptions of anatomic changes to be considered for each diagnostic imaging modality. The MDA criteria take into account the fact that the structure of bone rarely heals such that the bone has the same appearance as the original even if treatment was significantly effective (complete response). For example, according to the MDA criteria, recalcification of the rim of an osteolytic lesion on XR or CT (Figure 3A) is considered partial response, and an increase in the area of lysis (Figure 3B) is considered progressive disease.

Bottom Line: With the MDA criteria, there were significant differences in PFS between patients classified as responders and those classified as nonresponders (P=0.025), but with the WHO criteria, there were not.Application of the MDA classification may allow bone lesions to be considered measurable disease.Prospective study is needed to test the MDA classification among patients with bone metastasis.

View Article: PubMed Central - PubMed

Affiliation: Department of Stem Cell Transplantation and Cellular Therapy, The University of Texas M. D. Anderson Cancer Center, Houston, 77030, USA.

ABSTRACT

Background: We compared the utility of a new response classification (MDA; based on computed tomography (CT), magnetic resonance imaging (MRI), plain radiography (XR), and skeletal scintigraphy (SS)) and the World Health Organisation response classification (WHO; based on XR and SS) in stratifying breast cancer patients with bone-only metastases with respect to progression-free survival (PFS), overall survival (OS), and clinical response.

Methods: We retrospectively reviewed 41 patients with bone-only metastatic breast cancer and assigned responses according to the MDA and WHO criteria. We analysed whether the MDA or WHO response classifications correlated with PFS and OS.

Results: With the MDA criteria, there were significant differences in PFS between patients classified as responders and those classified as nonresponders (P=0.025), but with the WHO criteria, there were not. Neither criteria distinguished responders from nonresponders in terms of OS. MDA response criteria correlated better than WHO response criteria with clinical response assessment.

Conclusions: The MDA classification is superior to the WHO classification in differentiating between responders and nonresponders among breast cancer patients with bone-only metastases. Application of the MDA classification may allow bone lesions to be considered measurable disease. Prospective study is needed to test the MDA classification among patients with bone metastasis.

Show MeSH
Related in: MedlinePlus