Published in:
01-09-2017 | Review Article
Radiological Response to the Locoregional Treatment in Hepatocellular Carcinoma: RECIST, mRECIST, and Others
Published in: Journal of Gastrointestinal Cancer | Issue 3/2017
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Hepatocellular carcinoma (HCC) is the sixth most common tumor worldwide [1]. Locoregional treatment choices for HCC include molecular-targeted chemotherapy, yttrium-90 radioembolization, and interventional radiological methods including transcatheter arterial chemoembolization (TACE) and radiofrequency ablation (RFA) [2, 3]. Imaging has a very important role in the management of HCC and the efficacy of treatment is usually monitored and evaluated radiologically. Response to therapy has been evaluated by morphologic methods using different criteria such as the World Health Organization (WHO) criteria or the Response Evaluation Criteria in Solid Tumors (RECIST) in treatment (Table 1). However, the development of advanced therapies has required novel methods for evaluating response to treatment. This need has led to development of tumor- or therapy-specific guidelines such as the modified computed tomography (CT) Response Evaluation (Choi) Criteria for gastrointestinal stromal tumors, the European Association for Study of the Liver (EASL) criteria, and modified RECIST (mRECIST) (Table 2) for HCC [4‐7]. mRECIST based on changes in viable tumor has become the guideline for HCC being treated with targeted treatments. Imaging for tumor response evaluation has evolved over the past few years as a result of advances in imaging techniques and new available imaging parameters including new functional advanced imaging methods. In this review, we discuss radiological response methods to evaluate tumor response in the management of HCC.
Table 1
Morphologic response criteria of HCC treatment
|
WHO
|
RECIST
|
|
|---|---|---|
|
CR
|
Disappearance of all lesions
|
Disappearance of all lesions and pathologic lymph nodes
|
|
PR
|
≥50% decrease in the sum of the area (the longest diameters multiplied by the longest perpendicular diameters)
|
≥30% decrease in the sum of the longest diameters of targeted lesions
|
|
SD
|
Neither PR nor PD
|
Neither PR nor PD
|
|
PD
|
>25% increase in the sum of the area
|
>20% increase in the sum of the longest diameters and ≥5-mm absolute increase in the sum of the longest diameters
|
Table 2
Summary of response criteria of HCC treatment based on tumor viability and density
|
EASL
|
mRECIST
|
Choi
|
|
|---|---|---|---|
|
CR
|
Disappearance of intratumoral arterial enhancement
|
Disappearance of all lesions and pathologic lymph nodes
|
Disappearance of all lesions
|
|
PR
|
≥50% decrease in the sum of the arterial enhancing areas (the longest diameters multiplied by the longest perpendicular diameters)
|
≥30% decrease in the sum of diameters of enhancing target lesions
|
≥10% decrease in the longest diameter of target lesion or ≥15% decrease in attenuation (HU)
|
|
SD
|
Neither PR nor PD
|
Neither PR nor PD
|
Neither PR nor PD
|
|
PD
|
≥25% increase in the size of the arterial enhancing areas or development of a new lesion
|
≥20% increase in the sum of diameters of viable target lesions recorded since treatment started or development of new lesions
|
≥10% increase in the longest diameter of target lesion without PR criteria or development of new lesions
|