Radiological Morphology of Colorectal Liver Metastases after Preoperative Chemotherapy Predicts Tumor Viability and Postoperative Outcomes

Abstract

The CT morphology of CLM predicts tumor viability and long-term surgical outcomes after chemotherapy.

Changes in CT morphology can be an independent response marker for patients receiving regorafenib for colorectal liver metastases: retrospective pilot study

“…Interestingly, a significantly longer PFS was observed in patients with optimal morphologic responses, though all 3 patients exhibited an increase in tumor size at the time of the diagnosis of the morphologic response. Although previous studies have confirmed that the morphologic response occurs independently of the size response, [ 4 , 6 , 8 ] given that 40%–60% of patients with the optimal responses also exhibited size-based responses, [ 6 , 8 ] the patterns of response observed in the present study seem to differ from those reported for first-line chemotherapy.…”

“…The CT morphologic response to chemotherapy has been reported to be a good prognostic indicator in both medical [ 4 , 11 ] and surgical [ 4 , 6 , 8 ] populations with colorectal liver metastases, especially in patients treated with bevacizumab. The reported strength of a CT morphologic response is that it may predict differences in pathological response “quality,” [ 7 , 13 , 14 ] and a strong correlation between CT morphology and the pathological viability of tumors has been confirmed in previous studies.…”

“…The reported strength of a CT morphologic response is that it may predict differences in pathological response “quality,” [ 7 , 13 , 14 ] and a strong correlation between CT morphology and the pathological viability of tumors has been confirmed in previous studies. [ 4 , 6 , 8 ] The potential utility of the CT morphologic response for medical populations with unresectable tumors is that it could be used in decision-making processes to reduce the intensity of treatment during the maintenance phase of intensive chemotherapy. However, its usefulness in salvage-line treatment has never been reported.…”

“…Although a size-based response evaluation according to the RECIST is the gold standard, [ 3 ] some reports suggested the morphologic change should be taken into account especially in patients treated with a regimen that includes bevacizumab. [ 4 – 10 ] The computed tomographic (CT) morphologic response criteria [ 4 , 6 ] were proposed to assess the non-size-based response to chemotherapy (e.g., the pathologic response to chemotherapy), and the efficacy of these criteria has been validated in medical [ 11 ] and surgical [ 8 ] populations. Because regorafenib has an inhibitory effect on the same signal pathways that other anti-vascular endothelial growth factor (VEGF) antibodies block, its effect might need to be evaluated using non-size-based criteria similar to those required for bevacizumab.…”

Comparison of early radiological predictors of outcome in patients with colorectal cancer with unresectable hepatic metastases treated with bevacizumab

“…The learning curve is short and the interobserver agreement excellent across a wide range of experience. It was recently confirmed by an independent group from Japan 14. The only limitation to the scoring is the image quality.…”