Is it time to move from the Unidimensional RECIST 1.1 Response Assessment Criteria to a Volumetric Evaluation in the Present Era of Image-based Oncology? An Evaluation in Locally Advanced Head Neck Cancers Undergoing Treatment

• Published in: Clinical oncology (Royal College of Radiologists (Great Britain)) Vol. 36; no. 10; pp. 615 - 623
• Main Authors: Kale, P., Datta, S., Kalbande, P., Aher, P., Singh, A., Datta, N.R.
• Format: Journal Article
• Language: English
• Published: England Elsevier Ltd 01.10.2024
• Subjects: Adult; Aged; Aged, 80 and over; Chemoradiotherapy - methods; Female; Head and Neck Neoplasms - diagnostic imaging; Head and Neck Neoplasms - pathology; Head and Neck Neoplasms - radiotherapy; Head and Neck Neoplasms - therapy; Humans; Locally advanced head neck cancer; Male; Middle Aged; Radiotherapy; RECIST; Response Evaluation Criteria in Solid Tumors; Tomography, X-Ray Computed - methods; Tumor Burden; Tumour response; Tumour volume; Volumetric assessment; Locally advanced head neck cancer; Tumour response; RECIST; Radiotherapy; Volumetric assessment; Tumour volume
• ISSN: 0936-6555; 1433-2981; 1433-2981
• DOI: 10.1016/j.clon.2024.07.006

Tumour response assessments, as per Response Evaluation Criteria in Solid Tumours (RECIST 1.1), are based on the sum of diameters (SODs) of the primary tumour (longest diameter) and/or short axis diameter of lymph nodes. This study evaluates the response categorisation as per RECIST 1.1 vs Computed tomography (CT) based volumetric assessment of RECIST (proposed as vRECIST) in locally advanced head and neck cancers (LAHNCs) undergoing treatment. The pre-treatment SODs and CT estimated tumour volumes were recorded in 45 LAHNCs treated with radiotherapy (RT), chemoradiotherapy (CTRT) or thermochemoradiotherapy (HTCTRT). Tumour responses were assessed independently as per RECIST 1.1 and vRECIST by two radiation oncologists and grouped into complete response (CR), partial response (PR), stable disease (SD) or progressive disease (PD). These response groups were evaluated for the likely congruence of the two approaches, as categorised independently by these two observers. All patients in stages III (n = 7), IVA (n = 16) and IVB (n = 22) were inoperable and had received either RT alone (n = 1), CTRT (n = 12) or HTCTRT (n = 32). Based on SODs criteria of RECIST 1.1, of the 45 patients, 5 and 40 were grouped as PR and SD by the first observer, while this changed to 34 and 10, respectively and 1 PD, with vRECIST (p < 0.001). Similarly, for the second observer, the 4 PR and 41 SD grouped using RECIST 1.1 were recategorised to 34 PR, 10 SD, and 1 PD by vRECIST (p < 0.001). Thus, a mismatch of 66.6% and 68.8%, respectively, was evident by observers first and second in categorising SD based on SODs of RECIST 1.1 vs PR on vRECIST. Treatment responses in LAHNCs assessed using SODs resulted in significant uncertainties and failed to reflect actual volumetric changes in tumours during treatment. It is perhaps time to consider replacing the SODs of RECIST 1.1 with vRECIST for unequivocal tumour response categorisation in the present era of image-based oncology practice. •Tumour responses are assessed on %reduction in the sum of diameters (SODs) as per RECIST 1.1.•Pre- and post-treatment tumour volumes on computed tomography (CT) were evaluated for tumour response.•Gross mismatches in response categories grouped by SOD vs tumour volume were evident.•Revision of tumour response assessment criteria of RECIST 1.1 is strongly desirable.•Suggest to replace SOD with target volume (vRECIST) for tumour response assessments.