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Published on: September 9, 2020
Response Evaluation Criteria in Solid Tumors (RECIST) following neoadjuvant chemotherapy in osteosarcoma
Lillian M Guenther1, R Grant Rowe1, Patricia T Acharya2
1Dana-Farber/Boston Children's Cancer and Blood Disorders Center, Boston, Massachusetts.
Background:
In osteosarcoma, patient survival has not changed in over 30 years. Multiple phase II trials have been conducted in osteosarcoma using the Response Evaluation Criteria in Solid Tumors (RECIST) as a primary endpoint; however, none of these have revealed new treatment strategies. We investigated RECIST in newly diagnosed patients who received neoadjuvant chemotherapy proven to be beneficial.
Methods:
Patients treated from 1986 to 2011 for newly diagnosed osteosarcoma with paired tumor imaging before and after adequate neoadjuvant chemotherapy were included in this retrospective study. Two radiologists performed independent, blinded (to image timing) RECIST measurements of primary tumor and lung metastases at diagnosis and post-neoadjuvant chemotherapy. Association between RECIST and histological necrosis and outcome were assessed.
Results:
Seventy-four patients met inclusion criteria. Five-year overall survival and progression-free survival (PFS) were 77 ± 7% and 61 ± 8%, respectively. No patients had RECIST partial or complete response in the primary tumor. Sixty-four patients (86%) had stable disease, and 10 (14%) had progressive disease (PD). PD in the primary tumor was associated with significantly worse PFS in localized disease patients (P = 0.02). There was no association between RECIST in the primary tumor and necrosis. There were an insufficient number of patients with lung nodules ≥1 cm at diagnosis to evaluate RECIST in pulmonary metastases.
Conclusions:
PD by RECIST predicts poor outcome in localized disease patients. In bone lesions, chemotherapy proven to improve overall survival does not result in radiographic responses as measured by RECIST. Further investigation of RECIST in pulmonary metastatic disease in osteosarcoma is needed.
Insights
Progressive disease in osteosarcoma, as measured by RECIST, predicts poor outcomes in localized disease. However, RECIST does not show radiographic responses in bone lesions despite chemotherapy improving survival.
Area of Science:
- Oncology
- Radiology
- Medical Imaging
Background:
- Osteosarcoma patient survival rates have stagnated for over three decades.
- Previous Phase II trials in osteosarcoma using Response Evaluation Criteria in Solid Tumors (RECIST) have not yielded new treatment strategies.
- This study examines RECIST in newly diagnosed osteosarcoma patients receiving neoadjuvant chemotherapy.
Purpose of the Study:
- To investigate the utility of RECIST in assessing treatment response in newly diagnosed osteosarcoma patients undergoing neoadjuvant chemotherapy.
- To determine the association between RECIST measurements, histological necrosis, and patient outcomes.
- To evaluate the predictive value of RECIST for overall survival and progression-free survival (PFS).
Main Methods:
- Retrospective analysis of 74 newly diagnosed osteosarcoma patients treated between 1986 and 2011.
- Paired tumor imaging before and after neoadjuvant chemotherapy was assessed.
- Independent, blinded RECIST measurements of primary tumors and lung metastases were performed by two radiologists.
Main Results:
- No patients achieved RECIST partial or complete response in the primary tumor; 86% had stable disease, 14% had progressive disease (PD).
- PD in the primary tumor was significantly associated with worse PFS in localized disease (P=0.02).
- No correlation was found between RECIST in the primary tumor and histological necrosis; insufficient data for pulmonary metastases.
Conclusions:
- RECIST progressive disease is a predictor of poor outcomes in localized osteosarcoma.
- Standard neoadjuvant chemotherapy, while improving survival, does not yield RECIST radiographic responses in primary bone lesions.
- Further research is required to evaluate RECIST in pulmonary metastatic osteosarcoma.
