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Predicting clinical outcomes in chordoma patients receiving immunotherapy: a comparison between volumetric
Kathleen E Fenerty1, Les R Folio2, Nicholas J Patronas2
1Laboratory of Tumor Immunology and Biology, Center for Cancer Research, National Cancer Institute, National Institutes of Health, 10 Center Drive, Room 13N208, Bethesda, MD, 20892, USA.
Background:
The Response Evaluation Criteria in Solid Tumors (RECIST) are the current standard for evaluating disease progression or therapy response in patients with solid tumors. RECIST 1.1 calls for axial, longest-diameter (or perpendicular short axis of lymph nodes) measurements of a maximum of five tumors, which limits clinicians' ability to adequately measure disease burden, especially in patients with irregularly shaped tumors. This is especially problematic in chordoma, a disease for which RECIST does not always adequately capture disease burden because chordoma tumors are typically irregularly shaped and slow-growing. Furthermore, primary chordoma tumors tend to be adjacent to vital structures in the skull or sacrum that, when compressed, lead to significant clinical consequences.
Methods:
Volumetric segmentation is a newer technology that allows tumor burden to be measured in three dimensions on either MR or CT. Here, we compared the ability of RECIST measurements and tumor volumes to predict clinical outcomes in a cohort of 21 chordoma patients receiving immunotherapy.
Results:
There was a significant difference in radiologic time to progression Kaplan-Meier curves between clinical outcome groups using volumetric segmentation (P = 0.012) but not RECIST (P = 0.38). In several cases, changes in volume were earlier and more sensitive reflections of clinical status.
Conclusion:
RECIST is a useful evaluation method when obvious changes are occurring in patients with chordoma. However, in many cases, RECIST does not detect small changes, and volumetric assessment was capable of detecting changes and predicting clinical outcome earlier than RECIST. Although this study was small and retrospective, we believe our results warrant further research in this area.
Insights
Volumetric segmentation offers a more sensitive method than RECIST for assessing tumor burden and predicting outcomes in chordoma patients undergoing immunotherapy, especially for irregularly shaped tumors.
Area of Science:
- Oncology
- Radiology
- Medical Imaging
Background:
- The Response Evaluation Criteria in Solid Tumors (RECIST) is the standard for evaluating tumor progression but has limitations for irregularly shaped tumors like chordoma.
- Chordoma tumors' irregular shape and slow growth can lead to inadequate disease burden assessment by RECIST, impacting clinical management.
Purpose of the Study:
- To compare the efficacy of volumetric segmentation versus RECIST measurements in predicting clinical outcomes for chordoma patients receiving immunotherapy.
- To determine if volumetric assessment offers earlier and more sensitive detection of disease changes compared to RECIST.
Main Methods:
- A cohort of 21 chordoma patients receiving immunotherapy was analyzed.
- Tumor burden was assessed using both RECIST measurements and three-dimensional volumetric segmentation from MR or CT scans.
- The ability of each method to predict clinical outcomes was compared.
Main Results:
- Volumetric segmentation showed a significant difference in radiologic time to progression Kaplan-Meier curves (P=0.012), unlike RECIST (P=0.38).
- Changes in tumor volume were observed to be earlier and more sensitive indicators of clinical status in several cases.
Conclusions:
- Volumetric assessment is more sensitive than RECIST for detecting subtle changes and predicting clinical outcomes in chordoma patients.
- While RECIST is useful for obvious tumor changes, volumetric segmentation provides a more comprehensive evaluation, particularly for irregularly shaped chordomas.
