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RECIST revised: implications for the radiologist. A review article on the modified RECIST guideline.

van Persijn van Meerten EL, Gelderblom H, Bloem JL - Eur Radiol (2009)

Bottom Line: The purpose of this review article is to familiarize radiologists with the recently revised Response Evaluation Criteria in Solid Tumours (RECIST), used in many anticancer drug trials to assess response and progression rate.The most important modifications are: a reduction in the maximum number of target lesions from ten to five, with a maximum of two per organ, with a longest diameter of at least 10 mm; in lymph nodes (LNs) the short axis rather than the long axis should be measured, with normal LN measuring <10 mm, non-target LN >or=10 mm but <15 mm and target LN >or=15 mm; osteolytic lesions with a soft tissue component and cystic tumours may serve as target lesions; an additional requirement for progressive disease (PD) of target lesions is not only a >or=20% increase in the sum of the longest diameter (SLD) from the nadir but also a >or=5 mm absolute increase in the SLD (the other response categories of target lesion are unchanged); PD of non-target lesions can only be applied if the increase in non-target lesions is representative of change in overall tumour burden; detailed imaging guidelines.Alternative response criteria in patients with hepatocellular carcinoma and gastrointestinal stromal tumours are discussed.

View Article: PubMed Central - PubMed

Affiliation: Department of Radiology, Leiden University Medical Center, PO Box 9600, 2300 RC Leiden, The Netherlands. epersijn@lumc.nl

ABSTRACT
The purpose of this review article is to familiarize radiologists with the recently revised Response Evaluation Criteria in Solid Tumours (RECIST), used in many anticancer drug trials to assess response and progression rate. The most important modifications are: a reduction in the maximum number of target lesions from ten to five, with a maximum of two per organ, with a longest diameter of at least 10 mm; in lymph nodes (LNs) the short axis rather than the long axis should be measured, with normal LN measuring <10 mm, non-target LN >or=10 mm but <15 mm and target LN >or=15 mm; osteolytic lesions with a soft tissue component and cystic tumours may serve as target lesions; an additional requirement for progressive disease (PD) of target lesions is not only a >or=20% increase in the sum of the longest diameter (SLD) from the nadir but also a >or=5 mm absolute increase in the SLD (the other response categories of target lesion are unchanged); PD of non-target lesions can only be applied if the increase in non-target lesions is representative of change in overall tumour burden; detailed imaging guidelines. Alternative response criteria in patients with hepatocellular carcinoma and gastrointestinal stromal tumours are discussed.

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This 67-year-old male patient with non-Hodgkin lymphoma had enlarged target (arrows) and non-target (arrowheads) retroperitoneal lymph nodes on this CT image at baseline (a). After chemotherapy (b), these lymph nodes are still visible, but of normal size, categorising this patient as CR according to RECIST 1.1
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Fig3: This 67-year-old male patient with non-Hodgkin lymphoma had enlarged target (arrows) and non-target (arrowheads) retroperitoneal lymph nodes on this CT image at baseline (a). After chemotherapy (b), these lymph nodes are still visible, but of normal size, categorising this patient as CR according to RECIST 1.1

Mentions: In RECIST 1.1 [4], these issues are addressed. A lymph node is considered metastatic if at baseline the short axis is ≥10 mm. It is measurable (may serve as target lesion) if the short axis is ≥15 mm. A lymph node with a short axis ≥10 mm, but <15 mm at baseline is considered a non-target lymph node. If the short axis of a lymph node on follow-up studies drops below 10 mm, it is no longer considered pathologic, although continued measurement is needed to assess progression of these nodes on follow-up. This implies that a CR in patients is possible, while their SLD is not zero, if one or more target lesions are lymph nodes and all these lymph nodes have a short axis <10 mm on follow-up (Fig. 3) [4].Fig. 3


RECIST revised: implications for the radiologist. A review article on the modified RECIST guideline.

van Persijn van Meerten EL, Gelderblom H, Bloem JL - Eur Radiol (2009)

This 67-year-old male patient with non-Hodgkin lymphoma had enlarged target (arrows) and non-target (arrowheads) retroperitoneal lymph nodes on this CT image at baseline (a). After chemotherapy (b), these lymph nodes are still visible, but of normal size, categorising this patient as CR according to RECIST 1.1
© Copyright Policy
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC2872013&req=5

Fig3: This 67-year-old male patient with non-Hodgkin lymphoma had enlarged target (arrows) and non-target (arrowheads) retroperitoneal lymph nodes on this CT image at baseline (a). After chemotherapy (b), these lymph nodes are still visible, but of normal size, categorising this patient as CR according to RECIST 1.1
Mentions: In RECIST 1.1 [4], these issues are addressed. A lymph node is considered metastatic if at baseline the short axis is ≥10 mm. It is measurable (may serve as target lesion) if the short axis is ≥15 mm. A lymph node with a short axis ≥10 mm, but <15 mm at baseline is considered a non-target lymph node. If the short axis of a lymph node on follow-up studies drops below 10 mm, it is no longer considered pathologic, although continued measurement is needed to assess progression of these nodes on follow-up. This implies that a CR in patients is possible, while their SLD is not zero, if one or more target lesions are lymph nodes and all these lymph nodes have a short axis <10 mm on follow-up (Fig. 3) [4].Fig. 3

Bottom Line: The purpose of this review article is to familiarize radiologists with the recently revised Response Evaluation Criteria in Solid Tumours (RECIST), used in many anticancer drug trials to assess response and progression rate.The most important modifications are: a reduction in the maximum number of target lesions from ten to five, with a maximum of two per organ, with a longest diameter of at least 10 mm; in lymph nodes (LNs) the short axis rather than the long axis should be measured, with normal LN measuring <10 mm, non-target LN >or=10 mm but <15 mm and target LN >or=15 mm; osteolytic lesions with a soft tissue component and cystic tumours may serve as target lesions; an additional requirement for progressive disease (PD) of target lesions is not only a >or=20% increase in the sum of the longest diameter (SLD) from the nadir but also a >or=5 mm absolute increase in the SLD (the other response categories of target lesion are unchanged); PD of non-target lesions can only be applied if the increase in non-target lesions is representative of change in overall tumour burden; detailed imaging guidelines.Alternative response criteria in patients with hepatocellular carcinoma and gastrointestinal stromal tumours are discussed.

View Article: PubMed Central - PubMed

Affiliation: Department of Radiology, Leiden University Medical Center, PO Box 9600, 2300 RC Leiden, The Netherlands. epersijn@lumc.nl

ABSTRACT
The purpose of this review article is to familiarize radiologists with the recently revised Response Evaluation Criteria in Solid Tumours (RECIST), used in many anticancer drug trials to assess response and progression rate. The most important modifications are: a reduction in the maximum number of target lesions from ten to five, with a maximum of two per organ, with a longest diameter of at least 10 mm; in lymph nodes (LNs) the short axis rather than the long axis should be measured, with normal LN measuring <10 mm, non-target LN >or=10 mm but <15 mm and target LN >or=15 mm; osteolytic lesions with a soft tissue component and cystic tumours may serve as target lesions; an additional requirement for progressive disease (PD) of target lesions is not only a >or=20% increase in the sum of the longest diameter (SLD) from the nadir but also a >or=5 mm absolute increase in the SLD (the other response categories of target lesion are unchanged); PD of non-target lesions can only be applied if the increase in non-target lesions is representative of change in overall tumour burden; detailed imaging guidelines. Alternative response criteria in patients with hepatocellular carcinoma and gastrointestinal stromal tumours are discussed.

Show MeSH
Related in: MedlinePlus