Inter- and intraobserver consistency in assessing eligibility for bevacizumab (BVZ) in non-small-cell lung cancer (NSCLC) patients with centrally located tumors.
BACKGROUND
Bevacizumab (BVZ) combined with platinum-based therapy is registered for first-line treatment of nonsquamous non-small-cell lung cancer (NSCLC). Patients with centrally located tumors are stated ineligible for BVZ treatment. The goal of this study was to assess the consistency in evaluating eligibility of patients with central tumors for BVZ treatment.


METHODS
The study group was composed of 150 NSCLC patients with centrally located tumors. Eligibility for BVZ was assessed by chest computed tomography (CT) scan. Eligibility was assessed independently using CT images reviewed on workstations. Inter- and intraobserver variations on 50 randomly extracted patients were estimated through a statistical modeling (multiple correspondence analysis).


RESULTS
Discordance in eligibility was found for 82 patients (55%). The interobserver strength of agreement was fair to moderate (average kappa = 0.40). Contrarily, the intraobserver strength of agreement was good to very good (average kappa = 0.74). At multivariate analysis, the risk of discrepancy was essentially related to the assessment of the contact between the tumor and the vessels (odds ratio = 13.3, 95% confidence interval 2.8-62.6, P = 0.001).


CONCLUSIONS
The consistency in evaluating eligibility of patients with central tumors for BVZ treatment is weak. The study group indicated more stringent criteria to help physicians in taking the best treatment choice that need however to be prospectively validated.
Barlési
F
F
Department of Thoracic Oncology, Université de la Méditerranée-Assistance Publique Hôpitaux de Marseille, Marseille. Electronic address: fabrice.barlesi@mail.ap-hm.fr.
Balleyguier
C
C
Department of Radiology, Institut Gustave Roussy, Villejuif.
Besse
B
B
Department of Medical Oncology, Institut Gustave Roussy, Villejuif.
Bonodeau
F
F
Department of Radiology, Centre Oscar Lambret, Lille.
Brenac
F
F
Department of Radiology, Centre François Baclesse, Caen.
Corneloup
O
O
Department of Radiology, Centre Hospitalier Universitaire de Bordeaux, Bordeaux.
Dansin
E
E
Department of Medical Oncology, Centre Oscar Lambret, Lille.
Ferretti
G
G
Department of Radiology, Centre Hospitalier Universitaire de Grenoble, Grenoble.
Gaubert
J Y
JY
Department of Radiology, Assistance Publique Hôpitaux de Marseille, Marseille.
Gervais
R
R
Department of Medical Oncology, Centre François Baclesse, Caen.
Lacombe
C
C
Department of Radiology, Assistance Publique Hôpitaux de Paris, Paris.
Loundou
A
A
Department of Biostatistics, Assistance Publique Hôpitaux de Marseille, Marseille.
Moro-Sibilot
D
D
Department of Respiratory Diseases, Centre Hospitalier Universitaire de Grenoble, Grenoble.
Planchard
D
D
Department of Medical Oncology, Institut Gustave Roussy, Villejuif.
Scherpereel
A
A
Department of Respiratory Diseases, Centre Hospitalier Universitaire de Lille, Lille, France.
Menu
Y
Y
Department of Radiology, Assistance Publique Hôpitaux de Paris, Paris.
D020533:Angiogenesis Inhibitors / Q000627:therapeutic use*; D000911:Antibodies, Monoclonal / Q000627:therapeutic use*; D061067:Antibodies, Monoclonal, Humanized; D000068258:Bevacizumab; D002289:Carcinoma, Non-Small-Cell Lung / Q000000981:diagnostic imaging / Q000188:drug therapy*; D006801:Humans; D008175:Lung Neoplasms / Q000000981:diagnostic imaging / Q000188:drug therapy*; D015999:Multivariate Analysis; D015588:Observer Variation; D014057:Tomography, X-Ray Computed
D020533:Angiogenesis Inhibitors; D000911:Antibodies, Monoclonal; D061067:Antibodies, Monoclonal, Humanized; D000068258:Bevacizumab