Change in lung tumor volume as a biomarker of treatment response: a critical review of the evidence

Mozley, P. David; Schwartz, Lawrence H.; Bendtsen, Claus; Zhao, Binsheng; Petrick, Nicholas; Buckler, Andrew J.

doi:10.1093/annonc/mdq051

Cited by 85 publications

(65 citation statements)

References 32 publications

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“…Recent advances in imaging have made volumetric—rather than cross-sectional area—the preferred method of diagnostic assessment in many clinical settings. 33,34 Three-dimensional volumetric assessment of the psoas (i.e., total psoas volume (TPV)) has not been well studied or accepted as a means to define sarcopenia. As such, the objective of the current study was to evaluate the impact of sarcopenia on outcomes following curative resection of pancreatic cancer.…”

Section: Introductionmentioning

confidence: 99%

Impact Total Psoas Volume on Short- and Long-Term Outcomes in Patients Undergoing Curative Resection for Pancreatic Adenocarcinoma: a New Tool to Assess Sarcopenia

Amini

Spolverato

Gupta

et al. 2015

Journal of Gastrointestinal Surgery

208

219

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Background While sarcopenia is typically defined using total psoas area (TPA), characterizing sarcopenia using only a single axial cross-sectional image may be inadequate. We sought to evaluate total psoas volume (TPV) as a new tool to define sarcopenia and compare patient outcomes relative to TPA and TPV. Method Sarcopenia was assessed in 763 patients who underwent pancreatectomy for pancreatic adenocarcinoma between 1996 and 2014. It was defined as the TPA and TPV in the lowest sex-specific quartile. The impact of sarcopenia defined by TPA and TPV on overall morbidity and mortality was assessed using multivariable analysis. Result Median TPA and TPV were both lower in women versus men (both P<0.001). TPA identified 192 (25.1 %) patients as sarcopenic, while TPV identified 152 patients (19.9 %). Three hundred sixty-nine (48.4 %) patients experienced a postoperative complication. While TPA-sarcopenia was not associated with higher risk of postoperative complications (OR 1.06; P=0.72), sarcopenia defined by TPV was associated with morbidity (OR 1.79; P=0.002). On multivariable analysis, TPV-sarcopenia remained independently associated with an increased risk of postoperative complications (OR 1.69; P=0.006), as well as long-term survival (HR 1.46; P=0.006). Conclusion The use of TPV to define sarcopenia was associated with both short- and long-term outcomes following resection of pancreatic cancer. Assessment of the entire volume of the psoas muscle (TPV) may be a better means to define sarcopenia rather than a single axial image.

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Section: Introductionmentioning

confidence: 99%

Impact Total Psoas Volume on Short- and Long-Term Outcomes in Patients Undergoing Curative Resection for Pancreatic Adenocarcinoma: a New Tool to Assess Sarcopenia

Amini

Spolverato

Gupta

et al. 2015

Journal of Gastrointestinal Surgery

208

219

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“…There is some debate as to which assessment is most useful for the evaluation of therapeutic response. The 3D tumor size measurements have been shown to be more sensitive and accurate than 1D or 2D assessments in evaluating treatment response in patients with lung cancer, hepatocellular carcinoma, tuberous sclerosis, rhabdomyosarcoma, prostate cancer, and soft-tissue sarcomas (10)(11)(12)(13)(14)(15)(16). This increased sensitivity is more evident when the axial tumor area changes more than the longitudinal dimension, as is commonly seen in bone tumors (17).…”

Section: Discussionmentioning

confidence: 99%

Three-dimensional Radiologic Assessment of Chemotherapy Response in Ewing Sarcoma Can Be Used to Predict Clinical Outcome

Aghighi¹,

Boe²,

Rosenberg³

et al. 2016

Radiology

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Purpose:To compare the agreement of three-dimensional (3D) tumor measurements for therapeutic response assessment of Ewing sarcoma according to the Children's Oncology Group (COG) criteria, one-dimensional (1D) Response Evaluation Criteria in Solid Tumors (RECIST), and two-dimensional (2D) measurements defined by the World Health Organization (WHO) with tumor volume measurements as the standard of reference and to determine which method correlates best with clinical outcomes. Materials andMethods:This retrospective study was approved by the institutional review board of three institutions. Seventy-four patients (mean age 6 standard deviation, 14.5 years 6 6.5) with newly diagnosed Ewing sarcoma treated at three medical centers were evaluated. Primary tumor size was assessed on pre-and posttreatment magnetic resonance images according to 1D RECIST, 2D WHO, and 3D COG measurements. Tumor responses were compared with the standard of reference (tumor volume) on the basis of RECIST, COG, and WHO therapeutic response thresholds. Agreement between the percentage reduction measurements of the methods was assessed with concordance correlation, Bland-Altman analysis, and Spearman rank correlation. Agreement between therapeutic responses was assessed with Kendall tau and unweighted k statistics. Tumor responses were compared with patient survival by using the log-rank test, Kaplan-Meier plots, and Cox regression. Results:Agreement with the reference standard was significantly better for 3D measurement than for 1D and 2D measurements on the basis of RECIST and COG therapeutic response thresholds (concordance correlation of 0.41, 0.72, and 0.84 for 1D, 2D, and 3D measurements, respectively; P , .0001). Comparison of overall survival of responders and nonresponders demonstrated P values of .4133, .0112, .0032, and .0027 for 1D, 2D, 3D, and volume measurements, respectively, indicating that higher dimensional measurements were significantly better predictors of overall survival. Conclusion:The 3D tumor measurements according to COG are better predictors of therapeutic response of Ewing sarcoma than 1D RECIST or 2D WHO measurements and show a significantly higher correlation with clinical outcomes.q RSNA, 2016

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“…Mozley et al have reviewed literature findings regarding the use of volumetric CT in clinical studies and summarized their implications. 3 Alternatively, phantom studies provide a framework where the true lesion size can be established and allow for the investigation of a wide range of imaging parameters without concerns for patient safety. This allows for a much more robust and systematic comparison of measurement error across a range of factors (CT acquisition and nodule characteristics) such that the interactions between these factors can be identified.…”

Section: Introductionmentioning

confidence: 99%

Statistical analysis of lung nodule volume measurements with CT in a large‐scale phantom study

Gavrielides

Sahiner

et al. 2015

Medical Physics

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Purpose-To determine inter-related factors that contribute substantially to measurement error of pulmonary nodule measurements with CT by assessing a large-scale dataset of phantom scans and to quantitatively validate the repeatability and reproducibility of a subset containing nodules and CT acquisitions consistent with the Quantitative Imaging Biomarker Alliance (QIBA) metrology recommendations. Methods-The dataset has about 40 000 volume measurements of 48 nodules (5-20 mm, four shapes, three radiodensities) estimated by a matched-filter estimator from CT images involving 72 imaging protocols. Technical assessment was performed under a framework suggested by QIBA, which aimed to minimize the inconsistency of terminologies and techniques used in the literature. Accuracy and precision of lung nodule volume measurements were examined by analyzing the linearity, bias, variance, root mean square error (RMSE), repeatability, reproducibility, and significant and substantial factors that contribute to the measurement error. Statistical methodologies including linear regression, analysis of variance, and restricted maximum likelihood were applied to estimate the aforementioned metrics. The analysis was performed on both the whole dataset and a subset meeting the criteria proposed in the QIBA Profile document.Results-Strong linearity was observed for all data. Size, slice thickness × collimation, and randomness in attachment to vessels or chest wall were the main sources of measurement error. Grouping the data by nodule size and slice thickness × collimation, the standard deviation (3.9%-28%), and RMSE (4.4%-68%) tended to increase with smaller nodule size and larger slice thickness. For 5, 8, 10, and 20 mm nodules with reconstruction slice thickness ≤0.8, 3, 3, and 5 mm, respectively, the measurements were almost unbiased (−3.0% to 3.0%). Repeatability coefficients (RCs) were from 6.2% to 40%. Pitch of 0.9, detail kernel, and smaller slice thicknesses yielded better (smaller) RCs than those from pitch of 1.2, medium kernel, and larger slice thicknesses. Exposure showed no impact on RC. The overall reproducibility coefficient (RDC) was 45%, and reduced to about 20%-30% when the slice thickness and collimation were fixed. For nodules and CT imaging complying with the QIBA Profile (QIBA Profile subset), the measurements were highly repeatable and reproducible in spite of variations in nodule characteristics and imaging protocols. The overall measurement error was small and mostly due to a Electronic mail: qin.li1@fda.hhs.gov. HHS Public AccessAuthor manuscript Med Phys. Author manuscript; available in PMC 2017 November 01. Author Manuscript Author Manuscript Author ManuscriptAuthor Manuscript the randomness in attachment. The bias, standard deviation, and RMSE grouped by nodule size and slice thickness × collimation in the QIBA Profile subset were within ±3%, 4%, and 5%, respectively. RCs are within 11% and the overall RDC is equal to 11%. Conclusions-The authors have performed a comprehensive technical assessme...

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Change in lung tumor volume as a biomarker of treatment response: a critical review of the evidence

Abstract: The weight of the evidence indicates there are circumstances in which volumetric image analysis adds value to clinical trial science and the practice of medicine.

Cited by 85 publications

References 32 publications

Impact Total Psoas Volume on Short- and Long-Term Outcomes in Patients Undergoing Curative Resection for Pancreatic Adenocarcinoma: a New Tool to Assess Sarcopenia

Impact Total Psoas Volume on Short- and Long-Term Outcomes in Patients Undergoing Curative Resection for Pancreatic Adenocarcinoma: a New Tool to Assess Sarcopenia

Three-dimensional Radiologic Assessment of Chemotherapy Response in Ewing Sarcoma Can Be Used to Predict Clinical Outcome

Statistical analysis of lung nodule volume measurements with CT in a large‐scale phantom study

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