Introduction Tumor growth rate (TGR; percent size change per month [%/m]) is postulated to be an early radiological biomarker to overcome limitations of RECIST. This study aimed to assess the impact of TGR in neuroendocrine tumors (NETs) and potential clinical and therapeutic applications. Materials and Methods Patients (pts) with advanced grade (G) 1/2 NETs from the pancreas or small bowel initiating systemic treatment (ST) or watch and wait (WW) were eligible. Baseline and follow‐up scans were retrospectively reviewed to calculate TGR at pretreatment (TGR0), first follow‐up (TGRfirst), and 3(±1) months of study entry (TGR3m). Results Out of 905 pts screened, 222 were eligible. Best TGRfirst (222 pts) cutoff was 0.8 (area under the curve, 0.74). When applied to TGR3m (103 pts), pts with TGR3m <0.8 (66.9%) versus TGR3m ≥ 0.8 (33.1%) had longer median progression‐free survival (PFS; 26.3 m; 95% confidence interval [CI] 19.5–32.4 vs. 9.3 m; 95% CI, 6.1–22.9) and lower progression rate at 12 months (7.3% vs. 56.8%; p = .001). WW (vs. ST) and TGR3m ≥ 0.8 (hazard ratio [HR], 3.75; 95% CI, 2.21–6.34; p < .001) were retained as factors associated with a shorter PFS in multivariable Cox regression. TGR3m (HR, 3.62; 95% CI, 1.97–6.64; p < .001) was also an independent factor related to shorter PFS when analysis was limited to pts with stable disease (81 pts). Out of the 60 pts with TGR0 data available, 60% of pts had TGR0 < 4%/month. TGR0 ≥ 4 %/month (HR, 2.22; 95% CI, 1.15–4.31; p = .018) was also an independent factor related to shorter PFS. Conclusion TGR is an early radiological biomarker able to predict PFS and to identify patients with advanced NETs who may require closer radiological follow‐up. Implications for Practice Tumor growth rate at 3 months (TGR3m) is an early radiological biomarker able to predict progression‐free survival and to identify patients with advanced neuroendocrine tumors who may require closer radiological follow‐up. It is feasible to calculate TGR3m in clinical practice and it could be a useful tool for guiding patient management. This biomarker could also be implemented in future clinical trials to assess response to therapy.

Purpose: Tumor growth rate (TGR) represents the percentage change in tumor volume per month (%/m). Previous results from the GREPONET study showed that TGR measured after 3 months (TGR 3m ) of starting systemic treatment (ST) or watch and wait (WW) was an early biomarker predicting progression-free survival (PFS) in neuroendocrine tumors (NET).Experimental Design: Patients from 7 centers with advanced grade (G) 1/2 NETs from the pancreas (P)/small bowel (SB) initiating ST/WW were eligible. Computed tomography (CT)/MRI performed at prebaseline, baseline, and 3 (AE1) months of study entry were retrospectively reviewed. Aim-1: explore treatment-induced changes in TGR (DTGR 3m-BL ; paired T test), and Aim-2: validate TGR 3m (<0.8%/m vs. !0.8%/m) as an early biomarker in an independent cohort (Kaplan-Meier/Cox regression).Results: Of 785 patients screened, 127 were eligible. Mean (SD) TGR 0 and TGR 3m were 5.4%/m (14.9) and À1.4%/m (11.8), respectively. Mean (SD) DTGR 3m-BL paired-difference was À6.8%/m (19.3; P < 0.001). Most marked DTGR 3m-BL [mean (SD)] were identified with targeted therapies [À11.3%/m (4.7); P ¼ 0.0237] and chemotherapy [À7.9%/m (3.4); P ¼ 0.0261]. Multivariable analysis confirmed the absence of previous treatment (OR ¼ 4.65; 95% CI, 1.31-16.52; P ¼ 0.018) and low TGR 3m (continuous variable; OR 1.09; 95% CI, 1.01-1.19; P ¼ 0.042) to be independent predictors of radiologic objective response. When the multivariable survival analysis for PFS (Cox regression) was adjusted to grade (P ¼ 0.004) and stage (P ¼ 0.017), TGR 3m ! 0.8 (vs. <0.8) maintained its significance as a prognostic factor (P < 0.001), whereas TGR 0 and DTGR 3m-BL did not. TGR 3m ! 0.8%/m was confirmed as an independent prognostic factor for PFS [external validation; Aim-2; multivariable HR 2.21 (95% CI, 1.21-3.70; P ¼ 0.003)].Conclusions: TGR has a role as a biomarker for monitoring response to therapy for early identification of treatmentinduced changes and for early prediction of PFS and radiologic objective response.

Introduction: Tumor growth rate (TGR), percentage of change in tumor volume/month, has been previously identified as an early radiological biomarker for treatment monitoring in neuroendocrine tumor (NET) patients. We assessed the performance and reproducibility of TGR at 3 months (TGR 3m ) as a predictor factor of progression-free survival (PFS), including the impact of imaging method and reader variability. Methods: Baseline and 3-month (±1 month) CT/ MRI images from patients with advanced, grade 1-2 NETs were retrospectively reviewed by 2 readers. Influence of number of targets, tumor burden, and location of lesion on the performance of TGR 3m to predict PFS was assessed by uni/multivariable Cox regression analysis. Agreement between readers was assessed by Lin's concordance coefficient (LCC) and kappa coefficient (KC). Results: A total of 790 lesions were measured in 222 patients. Median PFS was 22.9 months. On univariable analysis, number of lesions (

Aim Flow redistribution is not uncommonly performed as a treatment strategy to optimize delivery of radioembolization particles to the liver. We quantitatively evaluated the effect of vessel embolization to promote flow redistribution when performing selective internal radiation therapy (SIRT) for liver metastases, and assessed long-term outcomes of treatment. Materials and Methods One hundred and fifty-eight SIRT procedures over an 8-year period were retrospectively reviewed. Twenty-three patients who underwent partial/whole embolization of the left hepatic artery were compared to a control group of 18 patients who did not receive any hepatic embolization as part of their work up. Counts were measured for each patient on both the post-99mTcMAA injection, and the post-90Y microspheres injection imaging. Recurrence and survival rates were also measured. Results A statistically significant shift in the right:left ratio between planning and treatment procedures was seen in patients who had vessel embolization in favor of the embolized lobe (p = 0.014). There was no significant difference in the time to recurrence in the embolized lobes versus the nonembolized lobes. No significant difference in overall survival was detected between the two cohorts. Conclusion To facilitate safe whole liver treatment, it is sometimes necessary to partially or completely occlude main or accessory hepatic arteries. This study shows that the success of flow redistribution strategies can be quantitatively measured, and there is no adverse impact on time to recurrence or overall survival outcomes.

James Blundell was an obstetrician, surgeon, physiologist and teacher. He is best known as the first to perform a successful human-to-human blood transfusion. However, he can also be accredited for significant advances in surgery and obstetrics. After a distinguished career at The United Hospitals of St Thomas and Guy's, he retired early and ended his years in relative obscurity.