Radiological characteristics of hepatocellular carcinoma that achieved complete response after chemoembolization with drug-eluting beads for liver transplantation planning

ABSTRACT Objective To describe the radiological characteristics of hepatocellular carcinoma (HCC) lesions that achieved a complete response following drug-eluting bead transarterial chemoembolization (DEB-TACE) preceding liver transplantation. Methods This single-center case-control study enrolled patients with hepatocellular carcinoma who underwent neoadjuvant DEB-TACE therapy, were followed up with contrast-enhanced magnetic resonance imaging or computed tomography, and were successively evaluated according to the modified Response Evaluation Criteria in Solid Tumors. The HCCs were divided into two groups based on their diameter (Group A: ≤3cm; Group B: 3cm). Viability was assessed using the Kaplan-Meier method according to tumor size categories. The relationship between tumor variables was analyzed using bivariate Cox regression. Results Three-hundred and twenty-eight patients with 667 hepatocellular carcinomas who underwent their first DEB-TACE session were enrolled. A total of 105 hepatocellular carcinomas in 59 patients exhibited complete response after the initial DEB-TACE session and were divided into Group A (92 HCCs) and Group B (13 HCCs). The diameter in Group A decreased significantly compared to the pre-procedure size until the second assessment (p<0.001), with no subsequent reduction in diameter, despite maintaining a complete response. In Group B, the reduction in diameter remained significant compared with the initial value until the sixth imaging evaluation (p=0.014). The average reduction was 45.1% for Group B and a maximum of 14.9% in Group A. Conclusion HCCs >3cm exhibited a greater reduction in size and a longer time to recurrence. HCCs ≤3cm had a shorter relapse time. The recurrence rates were similar. These findings may aid in planning for liver transplantation.

Serologically biochemical evaluation for patients with locally advanced/metastatic radioactive iodine-refractory differentiated thyroid cancer treated by apatinib / 中华核医学与分子影像杂志

Objective:To analyze the relationship between serologically biochemical response and the disease progression trend and prognosis evaluated by traditional structural imaging in patients with radioactive iodine-refractory differentiated thyroid cancer (RAIR-DTC) treated by apatinib.Methods:A retrospective study was performed on apatinib-treated (phase Ⅱ) patients ( n=19; 9 males, 10 females; age 46.0 (41.0, 57.5) years) with locally advanced/metastatic RAIR-DTC in Peking Union Medical College Hospital from March 2016 to June 2022. The relationships between serum thyroglobulin (Tg) and response evaluation criteria in solid tumors (RECIST) 1.1 structural imaging efficacy evaluation and disease progression trend were analyzed. The relationships between change of Tg after dose adjustment and the change of maximum diameter of target lesions in structure imaging were also discussed. Mann-Whitney U test and Wilcoxon signed-rank test were used to analyze the data. Results:During the median 49.41 months follow-up, the baseline Tg was 363.20(13.08, 2 490.50) μg/L. The Tg time-to-response was 0.47(0.47, 0.98) months, which was 1.80 (1.30, 1.90) months for RECIST 1.1. After 2, 4 and 8 weeks of initial treatment, the median Tg of the whole cohort decreased by 38.68%, 64.70% and 78.94%, respectively. After 8 weeks, the reducing degree of maximum diameter of target lesions was 33.48%. According to the best response, patients were divided into two groups: partial response (PR) group ( n=15) and stable disease (SD) group ( n=4). The median decreasing degree of Tg in PR group and that in SD group were 87.00% and 28.79%, and the reducing degree of maximum diameter of target lesions in corresponding groups were 45.00% and 21.22%. According to the final efficacy evaluation, patients were further divided into two groups: progressive disease (PD) group ( n=13) and non-PD (including PR and SD) group ( n=5). The median increasing degree of Tg in PD group was higher than that in non-PD group (381.55% vs 175.43%; U=10.00, P=0.037). The increasing degree of Tg and that of the maximum diameter of target lesions were 167.31% and 2.14% after the 1st adjustment, which were 231.06% and 9.73% after the 2nd adjustment. The differences of changes in Tg and maximum diameter of target lesions before and after the 1st dose adjustment were statistically significant ( z values: -3.06 and -2.23, P values: 0.002 and 0.026). Conclusion:During the apatinib treatment of RAIR-DTC, Tg can reflect the therapeutic effect of apatinib earlier than traditional imaging (RECIST 1.1), indicating the disease progression trend more sensitively.

Value of Modified Response Evaluation Criteria in Solid Tumors response in predicting the prognosis of patients with unresectable hepatocellular carcinoma patients after transarterial chemoembolization / 临床肝胆病杂志

ObjectiveTo investigate the association of Modified Response Evaluation Criteria in Solid Tumors (mRECIST) response with the prognosis of patients with unresectable hepatocellular carcinoma (HCC) after transarterial embolization (TACE). MethodsA retrospective analysis was performed for the clinical data of 190 patients with unresectable HCC who were consecutively admitted to Department of Liver Disease and Digestive Interventional Radiology, The First Affiliated Hospital of Air Force Medical University, and treated with TACE from January 2010 to December 2014. The mRECIST criteria were used to evaluate imaging response after TACE; the patients with complete response (CR) or partial response (PR) were enrolled as response group(n=89), and those with progressive disease (PD) or stable disease (SD) were enrolled as non-response group(n=101). The Kaplan-Meier method was used to calculate median survival time, and the log-rank test was used for comparison between groups; the Cox regression model was used to identify the influencing factors for prognosis. ResultsAccording to the mRECIST criteria, 39 patients (20.5%) achieved CR, 50 (26.3%) achieved PR, 67 (35.3%) had SD, and 34 (17.9%) had PD. The objective response rate based on mRECIST was 46.8% for the whole population. The response group had a significantly longer survival time than the non-response group, and the median survival time was 29.9 (95% confidence interval ［CI］: 25.0-34.8) months for the response group and 7.5 (95% CI: 5.7-9.3) months for the non-response group (P＜0.001). The multivariate analysis showed that mRECIST response (hazard ratio ［HR］=2.02, P＜0.001), hepatitis B (HR=4.03, P＜0.001), and portal invasion (HR=2.12, P=0.008) were independent risk factors for survival. ConclusionThe mRECIST response has a certain value in predicting the prognosis of patients with unresectable HCC after TACE.

A single center study on the relationship between the depth of remission and the efficacy of first-line TKI drugs / 中国医师杂志

Objective@#The aim of the study was to investigate association of response depth and prognosis in epidermal growth factor receptor (EGFR)-mutant non-small cell lung cancer (NSCLC)patients treated with first-line tyrosine kinase inhibitors (TKIs).@*Methods@#The clinicopathological data and prognosis information of patients with locally advanced or metastatic (ⅢB or Ⅳ) lung adenocarcinoma with EGFR classical (19del or 21L858R) mutation who were treated in our hospital from 2015 to 2016 were collected. The tumor remission depth [stable disease (SD), partial response (PR), complete response (CR)] was measured by recist 1.1 standard. The survival curve was drawn by Kaplan-Meier method and log rank test was performed.@*Results@#During the study period, 204 advanced lung adenocarcinoma patients with 19del or 21L858R mutation were treated with TKI drugs of the first generation. Among them, 24 patients were lost or unable to evaluate the efficacy, 20 patients were evaluated as progression disease (PD), 62 patients as SD, 98 patients as CR or PR. Disease control rate (DCR) and objective remission rate (ORR) were 88.9% and 54.4%, respectively. The median progression free survival time (PFS) was 12.6 months (95% CI: 10.9-14.4 months) and 13.1 months (95% CI: 11.6-14.7) for patients assessed as SD (group A) and CR or PR (group B), respectively, with no significant difference (P=0.27). Subgroup analysis showed that the median overall survival of patients with EGFR 19del and 21L858R mutations was 12.5 months (95% CI: 9.9-15.4) and 12.7 months (95% CI: 9.4-16.1), respectively, with no significant difference (P=0.66); Similar result was also observed in Group B with a median PFS of 13.9 months (95% CI: 12.3-15.5 months) and 12.3 months (95% CI: 9.5-15.1 months) in patients who had EGFR 19del or 21L858R mutations (P=0.41).@*Conclusions@#Response depth was not a positive predictor for prognosis in EGFR-mutant NSCLC patients treated with first-line TKIs.

A single center study on the relationship between the depth of remission and the efficacy of first-line TKI drugs / 中国医师杂志

Objective The aim of the study was to investigate association of response depth and prognosis in epidermal growth factor receptor (EGFR)-mutant non-small cell lung cancer (NSCLC)patients treated with first-line tyrosine kinase inhibitors (TKIs).Methods The clinicopathological data and prognosis information of patients with locally advanced or metastatic (Ⅲ B or Ⅳ) lung adenocarcinoma with EGFR classical (19del or 21L858R) mutation who were treated in our hospital from 2015 to 2016 were collected.The tumor remission depth [stable disease (SD),partial response (PR),complete response (CR)] was measured by recist 1.1 standard.The survival curve was drawn by Kaplan-Meier method and log rank test was performed.Results During the study period,204 advanced lung adenocarcinoma patients with 19del or 21L858R mutation were treated with TKI drugs of the first generation.Among them,24 patients were lost or unable to evaluate the efficacy,20 patients were evaluated as progression disease (PD),62 patients as SD,98 patients as CR or PR.Disease control rate (DCR) and objective remission rate (ORR) were 88.9％ and 54.4％,respectively.The median progression free survival time (PFS) was 12.6 months (95％ CI:10.9-14.4 months) and 13.1 months (95％ CI:11.6-14.7) for patients assessed as SD (group A) and CR or PR (group B),respectively,with no significant difference (P =0.27).Subgroup analysis showed that the median overall survival of patients with EGFR 19del and 21L858R mutations was 12.5 months (95％ CI:9.9-15.4) and 12.7 months (95％ CI:9.4-16.1),respectively,with no significant difference (P =0.66);Similar result was also observed in Group B with a median PFS of 13.9 months (95％ CI:12.3-15.5 months) and 12.3 months (95％ CI:9.5-15.1 months) in patients who had EGFR 19del or 21L858R mutations (P =0.41).Conclusions Response depth was not a positive predictor for prognosis in EGFR-mutant NSCLC patients treated with first-line TKIs.

Early evaluate the feasibility and reproducibility of sorafenib-targeted therapy for hepatocellular carcinoma by volume measurement approach / 中华放射学杂志

Objective Early evaluate the feasibility and reproducibility of sorafenib-targeted therapy for hepatocellular carcinoma by RECIST1.1, mRECIST and three-dimensional volume measurement. Methods Seventy patients with pathology or typical imaging findings confirmed as hepatocellular carcinoma along with the sorafenib-targeted treatment for more than 2 months between October 2004 to April 2017 in the Fifth Affiliated Hospital of Sun Yat-sen University were retrospectively analyzed. Patients underwent chest, abdominal and pelvic CT scans and enhanced scans before and after 2 weeks of sorafenib treatment. Two physicians used RECIST 1.1, mRECIST, and volume measurement criteria to evaluate the efficacy of treatment. According to their averaged results, the patients were divided into two groups (control group and non-control group). Kaplan-Meier survival analysis was used to compare the prognostic values between different response evaluation criterias for early predicting the efficacy of sorafenib-targeted therapy in advanced hepatocellular carcinoma. Kappa test was used to assess the efficacy response consistency in intra-group and inter-group. Results Based on mRECIST and RECIST 1.1 measurements, the control group included 34 cases, and the non-control group included 36 cases. Based on semi-automatic volume measurement, the control group included 38 cases, and the non-control group included 32 cases. Before the treatment with sorafenib, the RECIST 1.1 and mRECIST methods were used. There was a high degree of consistency between the two doctors (Kappa values were 0.79 and 0.71, respectively), and the semi-automatic volume measurement method was extremely consistent (Kappa value was 0.90); the consistency in intra-observer by three different methods was extremely high (Kappa values were 0.91, 0.85, 0.97, respectively). After the treatment with sorafenib, the consistency between the two radiologists using RECIST 1.1 measurement was high (Kappa value was 0.65), the consistency of mRECIST measurement was moderate (Kappa value was 0.52), and the consistency of tumor volume measurement was extremely high (Kappa The value was 0.83), the consistency in intra-observer using the above three methods was high or very high (Kappa values were 0.86, 0.74, 0.90, respectively). The RECIST 1.1 and mRECIST measurements were less sensitive in early evaluation of sorafenib-targeted treatment, and there was no significant difference between the control group and the non-control group (P=0.578 and 0.613) while the semi-automatic volumetric measurement was sensitive (P=0.004). Conclusion Semi-automated three-dimensional volume measurement which has better intra-and inter-group consistency and reproducibility can reflect the efficacy of sorafenib-targeted therapy for hepatocellular carcinoma in early stage.

Treatment progress and efficacy evaluation of bone metastasis in patients with prostate cancer / 肿瘤

Bone metastasis of prostate cancer is very common in the clinical practice. The bone metastasis-associated skeletal complications such as cancer-induced bone pain, pathological bone fractures and metastatic epidural spinal cord compression seriously affect the quality of life, reduce the overall survival of patients, and increase the financial burdens at home. Therefore, only the effective systemic therapy combined with the anti-bone metastasis treatment can reduce the occurrence of these complications, and prolong the overall survival of patients. At present, there are various treatments for the prostate cancer patients with bone metastasis, but no uniform standard to evaluate the therapeutic efficacy for the patients with simple bone metastasis of prostate cancer. In order to select the best treatment more conveniently, evaluate the therapeutic effect accurately and adjust the therapeutic regimen in time, this article reviews the current treatment methods, the latest study results and the mainstream evaluation criteria for bone metastasis of prostate cancer.

A comparison of the mRECIST and RECIST criteria in the efficacy assessment of systemic chemotherapy in patients with hepatocellular carcinoma / 中华肝胆外科杂志

Objective To compare the efficacy of the solid tumor evaluation criteria 1.1 (RECIST 1.1) and the revised solid tumor efficacy evaluation criteria (mRECIST) after chemotherapy in the hepatocellular carcinoma system.Methord Retrospective analysis of 34 patients with advanced hepatocellular carcinoma who underwent Folfox4 system chemotherapy from the Department of Hepatobiliary and Pancreatic Surgery of Dongfeng Hospital affiliated to Hubei Medical College from July 2017 to July 2018,including 24 males and 10 females.Spiral CT and/or MRI (four-phase) scans were performed 1 nonth,2 months,and every 2 months after treatment,and the effects were evaluated by RECIST 1.1 and mRECIST,respectively.The survival curve was drawn by Kaplan-Meier method,and log-rank test was used to compare survival curves.Result In 34 patients evaluated with the RECIST 1.1 criteria,0 patient showed complete remission (CR),6 patients partial remission (PR),20 patients stable disease (SD),and 8 patients progressive disease (PD).Using the mRECIST criteria,CR:0,PR:10,SD:17,and PD:7 patients.The Kappa value of the two methods was 0.271,95％ CI:0.010 ～0.535.The log-rank test showed that there was no significant difference in the survival curves of patients between PR,SD and PD in RECIST 1.1 (P ＞ 0.05).The cumulative survival rates were 40.0％,11.8％ and 0,respectively.The survival curves of patients with PR,SD and PD in mRECIST were statistically significant (P ＜ 0.05),and the cumulative survival rates were 37.5％,0,and 0,respectively.Conclusion The mRECIST criteria were more suitable than the RECIST 1.1 criteria in assessing efficacy of systemic chemotherapy for hepatocellular carcinoma.

Tumor Response Evaluation after Treatment and Post-treatment Surveillance of Hepatocellular Carcinoma

Hepatocellular carcinoma is one of the most prevalent malignancies and frequent causes of death worldwide. Treatment options of hepatocellular carcinoma consist of locoregional therapy, surgical resection, liver transplantation, and systemic therapy. Assessment of tumor response is required in patients receiving locoregional and systemic therapy. The Response Evaluation Criteria in Solid Tumors (RECIST) version 1.1 is widely used tumor response evaluation criteria. However, the RECIST does not reflect the extent of tumor necrosis after some locoregional therapies and molecular targeted agents. The Modified RECIST (mRECIST), which has the concept of viable tumor, was introduced in order to overcome this problem. The mRECIST were developed on the basis of RECIST version 1.1 and only tumoral tissue showing contrast uptake in arterial phase of dynamic radiologic imaging techniques was measured to assess tumor response. Recently, immune checkpoint inhibitors have emerged as a promising therapeutic modality for the treatment of hepatocellular carcinoma. To identify tumor response after immunotherapy, immune RECIST (iRECIST) has been proposed as consensusbased criteria. After achieving complete response after curative treatment, optimal surveillance was needed to detect recurrence. Individualized surveillance schedule should be considered, taking into consideration the risk factors of the patient and the risk associated with the treatment modalities.

Maximum diameter versus volumetric assessment for the response evaluation of vestibular schwannomas receiving stereotactic radiotherapy

PURPOSE: To explore the feasibility of maximum diameter as a response assessment method for vestibular schwannomas (VS) after stereotactic radiosurgery or fractionated stereotactic radiotherapy (RT), we analyzed the concordance of RT responses between maximum diameters and volumetric measurements. MATERIALS AND METHODS: Forty-two patients receiving curative stereotactic radiosurgery or fractionated stereotactic RT for VS were analyzed retrospectively. Twelve patients were excluded: 4 did not receive follow-up magnetic resonance imaging (MRI) scans and 8 had initial MRI scans with a slice thickness >3 mm. The maximum diameter, tumor volume (TV), and enhanced tumor volume (ETV) were measured in each MRI study. The percent change after RT was evaluated according to the measurement methods and their concordances were calculated with the Pearson correlation. The response classifications were determined by the assessment modalities, and their agreement was analyzed with Cohen kappa statistics. RESULTS: Median follow-up was 31.0 months (range, 3.5 to 86.5 months), and 90 follow-up MRI studies were analyzed. The percent change of maximum diameter correlated strongly with TV and ETV (r(p) = 0.85, 0.63, p = 0.000, respectively). Concordance of responses between the Response Evaluation Criteria in Solid Tumors (RECIST) using the maximum diameters and either TV or ETV were moderate (kappa = 0.58; 95% confidence interval, 0.32-0.85) or fair (kappa = 0.32; 95% confidence interval, 0.05-0.59), respectively. CONCLUSION: The percent changes in maximum diameter and the responses in RECIST were significantly concordant with those in the volumetric measurements. Therefore, the maximum diameters can be used for the response evaluation of VS following stereotactic RT.

Evaluation criteria for tumor efficacy in the times of immunotherapy / 国际肿瘤学杂志

With the advent of the times of immunotherapy and the emergence of a variety of unconventional response patterns such as delayed response and pseudo-progressive disease,a variety of immune-related efficacy evaluation criteria such as immune-related response criteria,immune-related response evaluation criteria in solid tumor and immune response evaluation criteria in solid tumor have been proposed successively.The evaluation principles and judgment results of these criteria are distinctly different from the traditional response evaluation criteria.In particular,the newly proposed immune response evaluation criteria in solid tumor introduces two new concepts of unconfirmed progressive disease and confirmed progressive disease and provides a new response evaluation model for solid tumors,which is expected to provide solutions to some of the most urgent clinical problems under the times of cancer immunotherapy.

Molecular Targeted Therapy in Modern Oncology: Imaging Assessment of Treatment Response and Toxicities

Oncology is a rapidly evolving field with a shift toward personalized cancer treatment. The use of therapies targeted to the molecular features of individual tumors and the tumor microenvironment has become much more common. In this review, anti-angiogenic and other molecular targeted therapies are discussed, with a focus on typical and atypical response patterns and imaging manifestations of drug toxicities.

Complete response of advanced hepatocellular carcinoma to sorafenib: another case and a comprehensive review

Since sorafenib was introduced in 2007 for treating advanced hepatocellular carcinoma (HCC), 15 patients have achieved a complete response (CR) in advanced HCC. However, only four of these reports can be regarded as real CRs involving adequate assessments including imaging, serum tumor markers, and histologic examinations of completely resected specimens. A 54-year-old man with hepatitis C virus (HCV)-related liver cirrhosis (LC) presented to our unit. A CT scan demonstrated a 3.8-cm arterial hypervascular/portal-washout mass in the right lobe and invasion in the right portal vein. Twelve weeks after beginning sorafenib therapy, the AFP level was normalized and a CT scan showed a prominent decrease in the hepatic mass and a significant decrease in the volume of portal vein thrombosis (PVT). The patient received a right liver hemihepatectomy after 12 months. No viable tumor cells were found in the resected specimen, and there was no thrombotic obstruction of the portal vein. Twelve months later the patient showed no clinical evidence of HCC recurrence. This is the first case of CR in HCC treatment following sorafenib with histologically confirmed HCV-related HCC without LC evidence, HCC with PVT, and a follow-up of longer than 12 months. This case seems to be an extremely unusual clinical outcome in advanced HCC.

Predição volumétrica de lesões pulmonares aplicando modelo oculto de Markov / Prediction volumetric of lung lesions applying hidden Markov model

OBJETIVO: predizer o estado volumétrico de lesões pulmonares aplicando o modelo oculto de Markov (HMM). MATERIAIS E MÉTODOS: Aquisição de imagens de lesões pulmonares temporais, geração do HMM e a aplicação do HMM. RESULTADOS: Os testes foram aplicados em 24 lesões pulmonares, adquiridas da Public Lung Database to Address Drug Response (PLDADR). Dividimos os resultados desta pesquisa em 3. O primeiro utilizando a base completa para predição volumétrica da lesão e comparação com o Response Evaluation Criteria in Solid Tumors (RECIST), atingindo uma taxa de acerto de 70,83%. No segundo, Aplica - se o método leave-one-out, separando os dados em dois grupos, treino e teste, obtendo-se uma taxa de acerto de 75,00%. Por fim, realizamos a predição volumétrica de cada lesão no intervalo de 5 tempos. O resultado mostrou que é possível predizer se o estado da lesão está progredindo, regredindo ou estabilizando, a partir das alterações ocorridas nos diâmetros e volumes.

OBJECTIVE: predicting the volume status of lung lesions by applying the hidden Markov model (HMM). MATERIALS AND METHODS: Acquisition of images of temporal lung lesions, HMM generation and application of HMM. RESULTS: The tests were applied in 24 pulmonary lesions, acquired from Public Lung Database to Address Drug Response(PLDADR). We have divided this search in 3. The first using the full volumetric basis for prediction of the lesion and compared to the Response Evaluation Criteria in Solid Tumors (RECIST), reaching a 70.83% success rate. Then, weapply the leave-one-out method, separating the data into two groups, training and testing, yielding a 75.00% successrate. Finally, we volumetric prediction of each lesion in 5 days interval. The result showed that it is possible to predict the state of the injury is progressing, regressing or stabilizing, from changes in the diameters and volumes.

Endoscopic Criteria for Evaluating Tumor Stage after Preoperative Chemoradiation Therapy in Locally Advanced Rectal Cancer / Journal of the Korean Cancer Association, 대한암학회지

PURPOSE: Local excision may be an another option for selected patients with markedly down-staged rectal cancer after preoperative chemoradiation therapy (CRT), and proper evaluation of post-CRT tumor stage (ypT) is essential prior to local excision of these tumors. This study was designed to determine the correlations between endoscopic findings and ypT of rectal cancer. MATERIALS AND METHODS: In this study, 481 patients with locally advanced rectal cancer who underwent preoperative CRT followed by surgical resection between 2004 and 2013 at a single institution were evaluated retrospectively. Pathological good response (p-GR) was defined as ypT ≤ 1, and pathological minimal or no response (p-MR) as ypT ≥ 2. The patients were randomly classified according to two groups, a testing (n=193) and a validation (n=288) group. Endoscopic criteria were determined from endoscopic findings and ypT in the testing group and used in classifying patients in the validation group as achieving or not achieving p-GR. RESULTS: Based on findings in the testing group, the endoscopic criteria for p-GR included scarring, telangiectasia, and erythema, whereas criteria for p-MR included nodules, ulcers, strictures, and remnant tumors. In the validation group, the kappa statistic was 0.965 (p < 0.001), and the sensitivity, specificity, positive predictive value, and negative predictive value were 0.362, 0.963, 0.654, and 0.885, respectively. CONCLUSION: The endoscopic criteria presented are easily applicable for evaluation of ypT after preoperative CRT for rectal cancer. These criteria may be used for selection of patients for local excision of down-staged rectal tumors, because patients with p-MR could be easily ruled out.

Clinical Characteristics and Continued Epidermal Growth Factor Receptor Tyrosine Kinase Inhibitor Administration in EGFR-mutated Non-Small Cell Lung Cancer with Skeletal Metastasis / Journal of the Korean Cancer Association, 대한암학회지

PURPOSE: The aim of this study was to analyze clinical characteristics of skeletal metastasis in epidermal growth factor receptor (EGFR) mutant non-small cell lung cancer (NSCLC) and treatment outcomes of continued EGFR tyrosine kinase inhibitor (TKI) therapy in patients presenting with skeletal metastasis progression. MATERIALS AND METHODS: Of the 216 patients treated with EGFR-TKI for management of stage III-IV NSCLC between 2006 and 2012 in Seoul St. Mary's Hospital, 76 patients with confirmed EGFR-mutated NSCLC with skeletal metastases during therapy were analyzed retrospectively. RESULTS: Of 76 patients with EGFR mutant lung cancer with skeletal metastasis, 37 patients developed first progressive disease (PD) in skeletal regions. EGFR-TKI was continued in these 37 patients after first PD in skeletal regions. Median time to first PD of skeletal regions was 8.9 months (95% confidence interval [CI], 4.8 to 13.0). Median time of continued EGFR-TKI after first PD of skeletal regions was 8.0 months (95% CI, 2.9 to 13.0) in patients with disease progression of preexisting regions, 5.6 months (95% CI, 4.5 to 6.7) in patients showing new localized regions, and 3.3 months (95% CI, 1.1 to 5.5) in patients with multiple new metastatic regions (p=0.006). Median time of postskeletal metastasis progression survival was 23.0 months (95% CI, 13.5 to 32.5), 15.0 months (95% CI, 3 to 34.7), and 7.0 months (95% CI, 6.0 to 8.0) (p=0.004) in the above described patient groups, respectively. Overall, seven patients (18.9%) had more than one episode of skeletal progression of disease without extraskeletal PD. CONCLUSION: Continued EGFR-TKI treatment with adequate local treatment after progression of skeletal metastasis may be considered for patients who show disease progression in preexisting regions or local progression.

Exploration of tumor response evaluation criteria in the era of tar-geted therapy / 中国肿瘤临床

The era of targeted molecular therapy for cancer has arrived. The mechanisms of targeted molecular drugs are different from those of chemotherapy drugs. The tumor response evaluation criteria that we currently use are the summary of experiences from evaluating the effect of chemotherapy drugs. Despite continuous improvement and standardization of the details, tumor response evalua-tion criteria, from the earliest WHO criteria to the improved RECIST and RECIST 1.1 criteria, are all based on measurement of tumor size, as chemotherapy drugs directly kill tumor cells. The aforementioned criteria are outlined in this review. However, targeted molecu-lar drugs mainly inhibit tumor cell proliferation. The effect of targeted molecular drugs on tumors is different from that of chemothera-py drugs. Thus, tumor response evaluation criteria suitable for targeted molecular drugs have been developed in recent years. This re-view introduces Choi criteria that use CT attenuation coefficient (Hounsfield unit [HU]) to describe tumor density. The criteria have measured indicators that include tumor size and tumor density. This review also introduces the following criteria derived from the Choi criteria for Modified Choi (mChoi) criteria size and attenuation CT (SACT), and morphology, attenuation, size, and structure (MASS).