ABSTRACT
BACKGROUND: Immunotherapy is a relatively new and developing modality in oncological treatment, which may significantly improve treatment results for some patients with malignant tumors. With the increasing number of clinical trials, the demand for a suitable tool to assess and compare treatment responses is growing. Currently, the most common response assessment system for solid tumors is RECIST (response Evaluation Criteria in Solid Tumors) version 1.1. However, in immuno-oncology, a small percentage of patients manifest a new response pattern termed pseudoprogression, in which, after the initial increase in tumor burden or after the discovery of new lesions, a response or at least a prolonged stabilization of the disease can occur. This patient group would be included in the progression category when using RECIST 1.1 and effective treatment would be discontinued. Therefore, iRECIST criteria were established to capture the phenomenon of pseudoprogression, the need for PD confirmation (according to RECIST 1.1) was introduced, and changes were made in the evaluation of new lesions. AIM: The present work introduces criteria for the evaluation of oncological responses in solid tumors using RECIST version 1.1 and iRECIST immunotherapy variant (including a brief overview of previous immune criteria). These criteria are compared in an immuno-oncological context and their potential pitfalls are discussed. CONCLUSION: iRECIST criteria were established by expert consensus; however, sufficient data for final validation has not yet been collected. As a result, RECIST 1.1 should be the primary assessment system in immuno-oncology. The use of iRECIST should be reserved for research purposes (testing and validation). Distinguishing pseudoprogression from true PD in patients treated with immunotherapy remains a major challenge in oncological imaging.Key words: RECIST - response criteria - immunotherapy - measurement - tumor burden The authors declare they have no potential conflicts of interest concerning drugs, products, or services used in the study. The Editorial Board declares that the manuscript met the ICMJE recommendation for biomedical papers.Submitted: 24. 9. 2017Accepted: 3. 10. 2017.
Subject(s)
Immunotherapy , Neoplasms/therapy , Response Evaluation Criteria in Solid Tumors , HumansABSTRACT
Ovarian cancer in Czech Republic takes first place in mortality among gynecological malignant tumours. In most cases it is diagnosed in advanced stages. Initial treatment is based on combination of radical surgery and adjuvant chemotherapy. In more than two thirds of cases ovarian cancer relapses sooner or later, very often without a chance to cure the patient. Unsatisfying result of standard treatment is reason of looking for more effective procedures. Targeted therapy is subject of research in last years. Positive effect of bevacizumab has been proved. Through inhibition of angiogenesis it leads to prolonging of interval to cancer progression.
Subject(s)
Disease Management , Molecular Targeted Therapy/methods , Ovarian Neoplasms/therapy , Female , HumansABSTRACT
Authors examine the influence of metal implants on the distribution of ionizing radiation in tissue. In vivo measurements in a patient are seldom possible. The risk can be assessed with sufficient accuracy on the basis of various experimental dosimetric methods, histological changes in the irradiated volume and the tolerance to the physical stress, published in the available literature. The analysis shows that the risk of significant dose inhomogeneity or the treatment toxicity is minimal if mentioned principles are adhered to. Radiotherapy indications and dosage should not be markedly changed on the basis of the presence of metal in the irradiated volume.
Subject(s)
Metals , Orthopedic Fixation Devices , Prostheses and Implants , Radiotherapy/adverse effects , Humans , Osteoradionecrosis/etiology , Radiation Dosage , Radiometry , Risk FactorsABSTRACT
Radiotherapy is an effective treatment modality of prostate carcinoma. Considering the limited radiosensitivity of this tumour it is necessary to use relatively high doses of radiation. Modern technology offers the possibility to perform high-dose radiotherapy with acceptable toxicity. The authors present various options of both external and internal irradiation. They point out that brachytherapy, previously considered less appropriate from the radiobiology aspect, is according to the current views and results a very suitable treatment modality of prostate cancer.
