Comparison of response evaluation criteria in solid tumors with volumetric measurements for estimation of tumor burden in pancreatic adenocarcinoma and hepatocellular carcinoma.
BACKGROUND
Response evaluation criteria in solid tumors (RECIST) is the accepted method for determining tumor progression. However, RECIST may not estimate disease burden accurately because the axial plane often does not produce the actual longest diameter. Volumetric measurements may be an alternative to better determine tumor size. Our aim was to compare volumetric measurements with RECIST in pancreatic ductal adenocarcinomas (PDA) and hepatocellular carcinomas (HCC).


METHODS
RECIST and volumetric measurements were determined in 9 patients with metastatic PDA and 17 patients with HCC who subsequently underwent liver transplantation. Gross pathologic measurements after hepatectomy also were analyzed for volumes.


RESULTS
Three-dimensional diameter in volumetric analysis was 38% and 36% higher than RECIST diameter in PDA and HCC, respectively (P < .01). However, RECIST yielded 78% and 23% larger estimated tumor volumes than volumetric analysis in PDA and HCC, respectively (P < .01). Gross pathologic volume in HCC showed a linear correlation with both volumetric analysis (r = .95; P < .01) and RECIST (r = .96; P < .01) but RECIST significantly overestimated gross pathologic volume by an average of 28% (P < .01) whereas volumetric analysis was similar to gross pathologic volume (P = .56). In categorizing treatment response in PDA, RECIST and volumetric analysis were in moderate agreement (κ = .49).


CONCLUSIONS
RECIST significantly may overestimate tumor burden compared with volumetric measurements in both PDA and HCC. Volumetric analysis may be the preferred method to detect tumor progression.
Department of Surgery, University of Iowa College of Medicine, Iowa City, IA 52242, USA.
Jessemae L
JL
Welsh
Kellie
K
Bodeker
Elizabeth
E
Fallon
Sundershan K
SK
Bhatia
John M
JM
Buatti
Joseph J
JJ
Cullen
D006528:Carcinoma, Hepatocellular / Q000473:pathology* / Q000628:therapy; D021441:Carcinoma, Pancreatic Ductal / Q000473:pathology* / Q000628:therapy; D018450:Disease Progression; D006801:Humans; D008113:Liver Neoplasms / Q000473:pathology* / Q000628:therapy; D008279:Magnetic Resonance Imaging; D015588:Observer Variation; D010190:Pancreatic Neoplasms / Q000473:pathology* / Q000628:therapy; D015203:Reproducibility of Results; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D047368:Tumor Burden