Response evaluation in mesothelioma: Beyond RECIST

Area of Science:

• Oncology
• Radiology
• Medical Imaging

Background:

• Malignant pleural mesothelioma (MPM) exhibits non-spherical growth, complicating tumor burden assessment with traditional size-based criteria like WHO and RECIST.
• Current management relies on CT and MRI, but their limitations in accurately reflecting treatment response in MPM are recognized.

Purpose of the Study:

• To review the current applications of CT and MRI in MPM management and treatment response assessment.
• To highlight and discuss emerging functional imaging techniques that may offer improved assessment of treatment response in MPM.

Main Methods:

• Review of existing literature on CT and MRI for MPM management.
• Discussion of current size-based tumor response criteria (WHO, RECIST, mRECIST).
• Exploration of functional imaging techniques including PET, DWI, and DCE-MRI.

Main Results:

• Traditional size-based criteria face challenges in accurately assessing MPM tumor burden due to irregular growth patterns.
• Functional imaging techniques offer quantitative measurements reflecting tumor pathophysiology, potentially improving treatment response evaluation.
• PET, DWI, and DCE-MRI show promise for more accurate assessment of treatment effects in MPM.

Conclusions:

• Accurate assessment of treatment response in MPM is critical for effective patient management.
• Functional imaging techniques represent a significant advancement over traditional size-based criteria for evaluating MPM treatment efficacy.
• Further research and integration of advanced imaging modalities are needed to optimize MPM patient care.