Imaging Tumor Response to Therapy

165 Pages·2012·3.993 MB·English

by  Giovannino Ciccone, Ileana Baldi (auth.), Massimo Aglietta, Daniele Regge (eds.)

Imaging Tumor Response to Therapy
Massimo Aglietta • Daniele Regge
Editors
Imaging Tumor
Response to Therapy
Foreword by Gary D. Webb
123
Editors
Massimo Aglietta Daniele Regge
Department of Medical Oncology Radiology Unit
University of Turin Institute for Cancer Research
Institute for Cancer Research and Treatment (IRCC)
and Treatment (IRCC) Candiolo (Turin)
Candiolo (Turin) Italy
Italy
ISBN 978-88-470-2612-4 ISBN 978-88-470-2613-1(eBook)
DOI 10.1007/978-88-470-2613-1
Springer Milan Dordrecht Heidelberg London New York
Library of Congress Control Number: 2012939431
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Measure what is measurable,
and make measurable what is not so.
Galileo Galilei
Preface
The first drugs for cancer chemotherapy became available more than 50 years ago.
At that time, these chemotherapeutic agents were observed to produce tumor
shrinkage and thus, in some cases, increased survival and even patient cure. The
identification of a potentially active therapy followed a very simple scheme: a
treatment producing a significant reduction of the tumor burden in a consistent per-
centage of patients (generally > 20%) was considered active and thus most likely
able to improve survival. Later, the need to anticipate the response to treatment
drove researchers to determine a measure that could be used as a surrogate for a
clinically meaningful endpoint. Accordingly, in 1979–1981 the World Health
Organization produced a set of imaging criteria to monitor the response to treat-
ment of patients enrolled in clinical trials, based on measurement of the longest
lesion diameter. In 2000, a set of new rules to define tumor response was published,
the Response Evaluation Criteria in Solid Tumors (RECIST), by the European
Organization for Research and Treatment of Cancer (EORTC) and the National
Cancer Institute.
Today, in addition to the numerous chemotherapeutic agents, new targeted-ther-
apy drugs are available, often used to treat the same disease as their predecessors.
Their mechanism of action is complex such that the dogma tumor shrinkage =
activitydoes not always hold true. Instead, targeted drugs are able to stabilize dis-
ease, which can increase patient survival and/or quality of life to a greater extent
than agents inducing a transient tumor shrinkage. Moreover, particularly with some
of the new agents that target specific molecular pathways, there is evidence that
tumor growth is strongly inhibited even if there is no change or a paradoxical
increase in tumor volume is observed at conventional imaging. Thus, in clinical
practice the decision whether or not to consider a treatment effective may be chal-
lenging.
These problems are amplified during drug development, when critical decisions
are made regarding the value of further efforts. Improved patient survival, the true
endpoint, is inappropriate in early clinical trials and even in randomized phase III
studies it is often difficult to determine because of the confounding effect of
sequential treatments. Thus, surrogate endpoints of activity have become crucial.
vii
viii Preface
The appreciation that a simple dimensional evaluation of the tumor might be
inappropriate or misleading has also forced oncologists and radiologists to estab-
lish more effective and straightforward criteria to define the activity and effects of
treatment. This problem is addressed in this volume and, although it is not solved,
we hope that the detailed discussion of specific clinical situations can contribute
and enhance the ongoing debate.
Massimo Aglietta and Daniele Regge
Contents
Part I Methodological Bases
1 Surrogate Endpoints of Clinical Benefit . . . . . . . . . . . . . . . . . . . . . . . . 3
Giovannino Ciccone and Ileana Baldi
2 Response to Treatment: the Role of Imaging . . . . . . . . . . . . . . . . . . . . 15
Francesco Sardanelli, Anastasia Esseridou, Angelo S. Del Sole and
Luca M. Sconfienza
Part II RECIST and Beyond: Assessing the Response to Treatment
in Metastatic Disease
3 Gastrointestinal Stromal Tumors . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 41
Giovanni Grignani, Paola Boccone, Teresio V retto and Stefano Cirillo
4 Renal Cancer . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 61
Cinzia Ortega, Camillo Porta, Manuela Racca and Filippo Russo
5 Liver Metastases in ColonCancer . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 77
Lorenzo Capussotti, Luca Viganò, Francesco Leone,
and Delia Campanella
Part III RECIST and Beyond: Assessing the Response to Treatment
in Locally Advanced Disease
6 Neoadjuvant Therapy in Breast Cancer . . . . . . . . . . . . . . . . . . . . . . . . 95
Laura Martincich, Ilaria Bertotto and Filippo Montemurro
ix
x Contents
7 Lung Cancer . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 109
Massimo Bellomi, Tommaso de Pas, Adele Tessitore
and Lorenzo Preda
8 Pancreatic Cancer . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 127
Marcello Orsi, Claudio Losio, Michele Reni, Nadia di Muzio, Francesco
De Cobelli and Alessandro Del Maschio
9 Hepatocellular Carcinoma . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 141
Franco Brunello and Andrea Veltri
Contributors
Ileana BaldiDepartment of Environmental Medicine and Public Health,
University of Padua, Padua, Italy
Massimo BellomiDepartment of Radiology, European Institute of Oncology,
Milan;Department of Medicine and Surgery, University of Milan, Milan, Italy
Ilaria BertottoRadiology Unit, Institute for Cancer Research and Treatment
(IRCC), Candiolo (Turin), Italy
Paola BocconeDivision of Medical Oncology, Institute for Cancer Research and
Treatment (IRCC), Candiolo (Turin), Italy
Franco BrunelloGastro-Hepatology, San Giovanni Battista Hospital, Turin, Italy
Delia CampanellaRadiology Unit, Institute for Cancer Research and Treatment
(IRCC), Candiolo (Turin), Italy
Lorenzo CapussottiSurgical Department, Division of Hepato-Bilio-Pancreatic
and Digestive Surgery, Mauriziano “Umberto I” Hospital, Turin, Italy
Giovannino CicconeUnit of Clinical Epidemiology, San Giovanni Battista
University Hospital and CPO Piemonte, Turin, Italy
Stefano CirilloDivision of Radiology, Mauriziano “Umberto I” Hospital,
Turin, Italy
Francesco De CobelliDepartment of Radiology, San Raffaele Hospital and
Experimental Imaging Center, Vita-Salute University, Milan, Italy
Tommaso De PasMedical Oncology Unit of Respiratory Tract and Sarcomas
New Drugs, Development Division, European Institute of Oncology, Milan, Italy
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