Tumor response assessment by modified Choi criteria in localized high‐risk soft tissue sarcoma treated with chemotherapy

Abstract

BACKGROUND. The objective of this study was to compare the prognostic relevance of Response Evaluation Criteria in Solid Tumors (RECIST) versus Choi criteria for the assessment of response in patients with high-risk soft tissue sarcoma of the extremities or trunk wall who received preoperative chemotherapy with or without radiotherapy in a phase 3 trial. METHODS. Patients received 3 cycles of preoperative epirubicin þ ifosfamide with or without radiotherapy. The diagnostic concordance between RECIST and Choi criteria and their correlation with overall survival (OS) and freedom from progression (FFP) were evaluated in a univariate Cox regression model. RESULTS. In 243 of 321 eligible patients, RECIST, Choi criteria, and histology were predictive for OS and FFP. In the subgroup of 69 patients who received chemotherapy alone and were evaluable by both RECIST and Choi criteria, Choi criteria were associated significantly with OS and FFP, whereas RECIST predicted only FFP, and the pattern of agreement observed between the 2 criteria was unsatisfactory. On a dichotomous scale, comparing objective response (complete and partial responses) and lack of response (stable and progressive disease) to preoperative chemotherapy according to RECIST and Choi criteria, only Choi criteria were predictive of OS and FFP, and fair agreement between RECIST and Choi criteria was observed. When lack of progression and progression were compared (complete and partial responses þ stable disease vs progressive disease), both assessment criteria were significantly predictive of OS and FFP, and there was substantial agreement between the 2 criteria. CONCLUSIONS. Response to chemotherapy with or without radiotherapy was associated with a better outcome in patients with high-risk soft tissue sarcoma. Choi criteria were better predictors than RECIST in patients who received preoperative chemotherapy alone. Cancer 2012;118:5857-66.

Quality of surgery and neoadjuvant combined therapy in the ISG-GEIS trial on soft tissue sarcomas of limbs and trunk wall

“…In Table 3, an explorative analysis of the relation between the microscopic margin status and the risk of LR and DM in the subset of patients treated with preoperative CT only according to the response to the therapy is also reported. The responses were both classified according to RECIST and/or Choi criteria [26]. The results reported in this table are clearly meant to be explorative and hypothesis-generating.…”

MRP1 Overexpression Determines Poor Prognosis in Prospectively Treated Patients with Localized High-Risk Soft Tissue Sarcoma of Limbs and Trunk Wall: An ISG/GEIS Study

“…This finding could be explained with reference to another substudy derived from the same trial. In this substudy, partial response was not able to anticipate better clinical outcome, RFS or OS, compared with stable disease according to RECIST criteria (36). Moreover, some progressive disease cases have been reported as complete pathologic response in the examination of surgical specimens.…”

mTOR-inhibitor treatment of metastatic renal cell carcinoma: contribution of Choi and modified Choi criteria assessed in 2D or 3D to evaluate tumor response

“…Previous studies have adopted 3D attenuation in order to improve upon the ability of RECIST to identify non-responders with localized high-risk soft-tissue sarcoma [13], locally advanced gastric cancer treated with cytotoxic drugs [14], or mRCC [15]. Smith et al [3], however, found that attention to tumour characteristics-e.g., necrosis on 2D images (morphology, attenuation, size, and structure [MASS] criteria)-was simpler and more accurate than 3D size and attenuation CT (SACT) measures for classifying responders versus non-responders.…”