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Princípios de Oncologia - Resenha / Principles of Oncology - Review
Cruz, Felipe Melo.
  • Cruz, Felipe Melo; Faculdade de Medicina do ABC. BR
RBM rev. bras. med ; 69(1,esp)jan. 2012.
Article in Portuguese | LILACS | ID: lil-639225
ABSTRACT

Purpose:

We use changes in tumor measurements to assess response and progression, both in routine care and as the primary objective of clinical trials. However, the variability of computed tomography (CT) -based tumor measurement has not been comprehensively evaluated. In this study, we assess the variability of lung tumor measurement using repeat CT scans performed within 15 minutes of each other and discuss the implications of this variability in a clinical context. Patients and

methods:

Patients with non-small-cell lung cancer and a target lung lesion ³ 1 cm consented to undergo two CT scans within a period of minutes. Three experienced radiologists measured the diameter of the target lesion on the two scans in a side-by-side fashion, and differences were compared.

Results:

Fifty-seven percent of changes exceeded 1 mm in magnitude, and 33% of changes exceeded 2 mm. Median increase and decrease in tumor measurements were +4.3% and -4.2%, respectively, and ranged from 23% shrinkage to 31% growth. Measurement changes were within ± 10% for 84% of measurements, whereas 3% met criteria for progression according to Response Evaluation Criteria in Solid Tumors (RECIST; ³ 20% increase). Smaller lesions had greater variability of percent measurement change (P = .005).

Conclusion:

Apparent changes in tumor diameter exceeding 1 to 2 mm are common on immediate reimaging. Increases and decreases less than 10% can be a result of the inherent variability of reimaging. Caution should be exercised in interpreting the significance of small changes in lesion size in the care of individual patients and in the interpretation of clinical trial results.
RESUMO
O artigo de Oxnard et al., publicado no Journal of Clinical Oncology, de agosto de 2011, aborda a diferença na avaliação de tomografias de tórax da mesma pessoa realizada com intervalo de 15 minutos. Estudos preliminares demonstram que o processo de captura de imagens pode distorcer o resultado da tomografia e por esse motivo o presente estudo objetivou comparar as imagens lado a lado pelo mesmo radiologista e avaliar a mudança percentual no tamanho do tumor. Os radiologistas não sabiam que as tomografias eram realizadas no mesmo dia e avaliaram as imagens como exames de controle de resposta ao tratamento convencional.Variações de medida de 1 e 2 mm ocorreram, respectivamente, em 57% e 33% e modificações no parâmetro de resposta foram mais frequentes em lesões pequenas.A mensagem deste artigo aos clínicos é de que não devemos ser categóricos em afirmar que um paciente apresentou progressão da doença apenas porque houve aumento milimétrico nas lesões pulmonares. Este cuidado deve ser ainda maior quando estamos diante de lesões pequenas de 1-2 cm com aumentos de até 2 mm. O RECIST 1.1 minimiza a possibilidade deste erro ao afirmar que para haver progressão da doença é necessário o aumento de 20% na soma dos maiores diâmetros das lesões-alvo quando este aumento ultrapassa 5 mm.
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Index: LILACS (Americas) Main subject: Severity of Illness Index / Tomography / Medical Oncology Type of study: Controlled clinical trial Limits: Humans Language: Portuguese Journal: RBM rev. bras. med Journal subject: Medicine Year: 2012 Type: Article Affiliation country: Brazil Institution/Affiliation country: Faculdade de Medicina do ABC/BR

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Index: LILACS (Americas) Main subject: Severity of Illness Index / Tomography / Medical Oncology Type of study: Controlled clinical trial Limits: Humans Language: Portuguese Journal: RBM rev. bras. med Journal subject: Medicine Year: 2012 Type: Article Affiliation country: Brazil Institution/Affiliation country: Faculdade de Medicina do ABC/BR