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Comparison of RECIST, EORTC criteria and PERCIST for evaluation of early response to chemotherapy in patients with non-small-cell lung cancer

  • Jingjie Shang
  • Xueying Ling
  • Linyue Zhang
  • Yongjin Tang
  • Zeyu Xiao
  • Yong Cheng
  • Bin Guo
  • Jian Gong
  • Li Huang
  • Hao Xu
Original Article

Abstract

Purpose

To compare the Response Evaluation Criteria in Solid Tumors (RECIST) 1.1, the European Organization for Research and Treatment of Cancer (EORTC) criteria and the Positron Emission Tomography Response Criteria in Solid Tumors (PERCIST) 1.0 using PET volume computer-assisted reading (PET VCAR) for response evaluation in patients with advanced non-small-cell lung cancer (NSCLC) treated with chemotherapy.

Methods

A total of 35 patients with NSCLC were included in this prospective study. All patients received standard chemotherapy and underwent 18F-FDG PET/CT scans before and after treatment. With the assistance of PET VCAR, the chemotherapeutic responses were evaluated according to the RECIST 1.1, EORTC criteria and PERCIST 1.0. Concordance among these protocols was assessed using Cohen’s κ coefficient and Wilcoxon’s signed-ranks test. Progression-free survival (PFS) was calculated using the Kaplan-Meier test.

Results

RECIST 1.1 and EORTC response classifications were discordant in 20 patients (57.1 %; κ = 0.194, P < 0.05), and RECIST 1.1 and PERCIST 1.0 classifications were discordant in 22 patients (62.9 %; κ = 0.139, P < 0.05). EORTC and PERCIST 1.0 classifications were discordant in only 4 patients (11.4 %), resulting in better concordance (κ = 0.804, P > 0.05). Patients with a partial remission according to RECIST 1.1 had significantly longer PFS (P < 0.001) than patients with progressive disease, but not significantly longer than patients with stable disease (P = 0.855). According to both the EORTC criteria and PERCIST 1.0, patients with a partial metabolic response had a significantly longer PFS than those with stable metabolic disease and those with progressive metabolic disease (P = 0.020 and P < 0.001, respectively, for EORTC; both P < 0.001 for PERCIST 1.0).

Conclusion

EORTC criteria and PERCIST 1.0 are more sensitive and accurate than RECIST 1.1 for the detection of an early therapeutic response to chemotherapy in patients with NSCLC. Although EORTC criteria and PERCIST 1.0 showed similar results, PERCIST 1.0 is preferred because detailed and unambiguous definitions are given. We also found that response evaluations with PERCIST 1.0 using a single lesion and multiple lesions gave similar response classifications.

Keywords

RECIST EORTC PERCIST Non-small cell lung cancer Response evaluation 

Notes

Acknowledgments

We would like to thank the staff members of the Department of Nuclear Medicine and PET/CT-MR Centre, First Affiliated Hospital of Jinan University, for their excellent technical support.

Compliance with ethical standards

Conflicts of interest

None.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the principles of the 1964 Declaration of Helsinki and its later amendments or comparable ethical standards. This article does not describe any studies with animals performed by any of the authors.

Informed consent

Informed consent was obtained from all individual participants included in the study.

References

  1. 1.
    Rossi A, Di Maio M. Platinum-based chemotherapy in advanced non-small-cell lung cancer: optimal number of treatment cycles. Expert Rev Anticancer Ther. 2016. doi: 10.1586/14737140.2016.1170596 Google Scholar
  2. 2.
    Moertel CG, Hanley JA. The effect of measuring error on the results of therapeutic trials in advanced cancer. Cancer. 1976;38:388–94.CrossRefPubMedGoogle Scholar
  3. 3.
    Miller AB, Hoogstraten B, Staquet M, Winkler A. Reporting results of cancer treatment. Cancer. 1981;47:207–14.CrossRefPubMedGoogle Scholar
  4. 4.
    Therasse P, Arbuck SG, Eisenhauer EA, Wanders J, Kaplan RS, Rubinstein L, et al. New guidelines to evaluate the response to treatment in solid tumors. European Organization for Research and Treatment of Cancer, National Cancer Institute of the United States, National Cancer Institute of Canada. J Natl Cancer Inst. 2000;92:205–16.CrossRefPubMedGoogle Scholar
  5. 5.
    Eisenhauer EA, Therasse P, Bogaerts J, Schwartz LH, Sargent D, Ford R, et al. New response evaluation criteria in solid tumours: revised RECIST guideline (version 1.1). Eur J Cancer. 2009;45:228–47.CrossRefPubMedGoogle Scholar
  6. 6.
    Hicks RJ. Role of 18F-FDG PET in assessment of response in non-small cell lung cancer. J Nucl Med. 2009;50 Suppl 1:31S–42.Google Scholar
  7. 7.
    Weber WA. Assessing tumor response to therapy. J Nucl Med. 2009;50 Suppl 1:1S–10S.CrossRefPubMedGoogle Scholar
  8. 8.
    Juweid ME, Cheson BD. Positron-emission tomography and assessment of cancer therapy. N Engl J Med. 2006;354:496–507.CrossRefPubMedGoogle Scholar
  9. 9.
    Wahl RL, Jacene H, Kasamon Y, Lodge MA. From RECIST to PERCIST: evolving considerations for PET response criteria in solid tumors. J Nucl Med. 2009;50 Suppl 1:122S–50.Google Scholar
  10. 10.
    Adams MC, Turkington TG, Wilson JM, Wong TZ. A systematic review of the factors affecting accuracy of SUV measurements. AJR Am J Roentgenol. 2010;195:310–20.CrossRefPubMedGoogle Scholar
  11. 11.
    Boellaard R. Standards for PET image acquisition and quantitative data analysis. J Nucl Med. 2009;50 Suppl 1:11S–20.CrossRefPubMedGoogle Scholar
  12. 12.
    Boellaard R. Need for standardization of 18F-FDG PET/CT for treatment response assessments. J Nucl Med. 2011;52 Suppl 2:93S–100.Google Scholar
  13. 13.
    Young H, Baum R, Cremerius U, Herholz K, Hoekstra O, Lammertsma AA, et al. Measurement of clinical and subclinical tumour response using [18F]-fluorodeoxyglucose and positron emission tomography: review and 1999 EORTC recommendations. European Organization for Research and Treatment of Cancer (EORTC) PET Study Group. Eur J Cancer. 1999;35:1773–82.CrossRefPubMedGoogle Scholar
  14. 14.
    Zasadny KR, Wahl RL. Standardized uptake values of normal tissues at PET with 2-[fluorine-18]-fluoro-2-deoxy-D-glucose: variations with body weight and a method for correction. Radiology. 1993;189:847–50.CrossRefPubMedGoogle Scholar
  15. 15.
    Sugawara Y, Zasadny KR, Neuhoff AW, Wahl RL. Reevaluation of the standardized uptake value for FDG: variations with body weight and methods for correction. Radiology. 1999;213:521–5.CrossRefPubMedGoogle Scholar
  16. 16.
    Fox JJ, Autran-Blanc E, Morris MJ, Gavane S, Nehmeh S, Van Nuffel A, et al. Practical approach for comparative analysis of multilesion molecular imaging using a semiautomated program for PET/CT. J Nucl Med. 2011;52:1727–32.CrossRefPubMedPubMedCentralGoogle Scholar
  17. 17.
    Ordu C, Selcuk NA, Akosman C, Eren OO, Altunok EC, Toklu T, et al. Comparison of metabolic and anatomic response to chemotherapy based on PERCIST and RECIST in patients with advanced stage non-small cell lung cancer. Asian Pac J Cancer Prev. 2015;16:321–6.CrossRefPubMedGoogle Scholar
  18. 18.
    Ding Q, Cheng X, Yang L, Zhang Q, Chen J, Li T, et al. PET/CT evaluation of response to chemotherapy in non-small cell lung cancer: PET response criteria in solid tumors (PERCIST) versus response evaluation criteria in solid tumors (RECIST). J Thorac Dis. 2014;6:677–83.PubMedPubMedCentralGoogle Scholar
  19. 19.
    Shankar LK, Hoffman JM, Bacharach S, Graham MM, Karp J, Lammertsma AA, et al. Consensus recommendations for the use of 18F-FDG PET as an indicator of therapeutic response in patients in National Cancer Institute Trials. J Nucl Med. 2006;47:1059–66.PubMedGoogle Scholar
  20. 20.
    Sebastian TB, Manjeshwar RM, Akhurst TJ, Miller JV. Objective PET lesion segmentation using a spherical mean shift algorithm. Med Image Comput Comput Assist Interv. 2006;9:782–9.PubMedGoogle Scholar
  21. 21.
    Kundel HL, Polansky M. Measurement of observer agreement. Radiology. 2003;228:303–8.CrossRefPubMedGoogle Scholar
  22. 22.
    Monteil J, Mahmoudi N, Leobon S, Roudaut PY, El Badaoui A, Verbeke S, et al. Chemotherapy response evaluation in metastatic colorectal cancer with FDG PET/CT and CT scans. Anticancer Res. 2009;29:2563–8.PubMedGoogle Scholar
  23. 23.
    Lee DH, Kim SK, Lee HY, Lee SY, Park SH, Kim HY, et al. Early prediction of response to first-line therapy using integrated 18F-FDG PET/CT for patients with advanced/metastatic non-small cell lung cancer. J Thorac Oncol. 2009;4:816–21.CrossRefPubMedGoogle Scholar
  24. 24.
    Wahl RL, Zasadny K, Helvie M, Hutchins GD, Weber B, Cody R. Metabolic monitoring of breast cancer chemohormonotherapy using positron emission tomography: initial evaluation. J Clin Oncol. 1993;11:2101–11.PubMedGoogle Scholar
  25. 25.
    Novello S, Vavala T, Levra MG, Solitro F, Pelosi E, Veltri A, et al. Early response to chemotherapy in patients with non-small-cell lung cancer assessed by [18F]-fluoro-deoxy-D-glucose positron emission tomography and computed tomography. Clin Lung Cancer. 2013;14:230–7.CrossRefPubMedGoogle Scholar
  26. 26.
    Mac MMP, Hicks RJ, Matthews JP, McKenzie A, Rischin D, Salminen EK, et al. Positron emission tomography is superior to computed tomography scanning for response-assessment after radical radiotherapy or chemoradiotherapy in patients with non-small-cell lung cancer. J Clin Oncol. 2003;21:1285–92.CrossRefGoogle Scholar
  27. 27.
    Ziai D, Wagner T, El Badaoui A, Hitzel A, Woillard JB, Melloni B, et al. Therapy response evaluation with FDG-PET/CT in small cell lung cancer: a prognostic and comparison study of the PERCIST and EORTC criteria. Cancer Imaging. 2013;13:73–80.CrossRefPubMedPubMedCentralGoogle Scholar
  28. 28.
    Skougaard K, Nielsen D, Jensen BV, Hendel HW. Comparison of EORTC criteria and PERCIST for PET/CT response evaluation of patients with metastatic colorectal cancer treated with irinotecan and cetuximab. J Nucl Med. 2013;54:1026–31.CrossRefPubMedGoogle Scholar
  29. 29.
    Huang EH, Heidt DG, Li CW, Simeone DM. Cancer stem cells: a new paradigm for understanding tumor progression and therapeutic resistance. Surgery. 2007;141:415–9.CrossRefPubMedGoogle Scholar
  30. 30.
    Al-Hajj M, Becker MW, Wicha M, Weissman I, Clarke MF. Therapeutic implications of cancer stem cells. Curr Opin Genet Dev. 2004;14:43–7.CrossRefPubMedGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2016

Authors and Affiliations

  • Jingjie Shang
    • 1
  • Xueying Ling
    • 1
  • Linyue Zhang
    • 1
  • Yongjin Tang
    • 1
  • Zeyu Xiao
    • 1
  • Yong Cheng
    • 1
  • Bin Guo
    • 1
  • Jian Gong
    • 1
  • Li Huang
    • 1
  • Hao Xu
    • 1
  1. 1.Department of Nuclear Medicine and PET/CT-MRI CentreThe First Affiliated Hospital of Jinan UniversityGuangzhouChina

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