Non Size Based Morphology Criteria for Assessment of Response in Patients with Liver Metastases of Gastrointestinal Origin Receiving Systemic Treatment

Document Type: Research Articles

Authors

1 Department of Clinical Oncology and Nuclear Medicine, Faculty of Medicine, Menoufia University, Sheben Elkom, Egypt.

2 Department of Radiodiagnosis, Faculty of Medicine, Menoufia University, Sheben Elkom, Egypt.

Abstract

Background and Aim: Liver is the main site of metastases of gastrointestinal cancers, chemotherapy with or
without targeted therapy is the standard treatment. Radiologic assessment of tumor response is usually done by
the use of Response Evaluation Criteria in Solid Tumor (RECIST) criteria. RECIST depends on tumor size changes but
it does not address morphologic changes as overall attenuation, enhancement and tumor liver interface changes which
may shown early before tumor size changes. We aimed to evaluate use of contrast enhanced computed tomography
(CECT) new morphologic criteria in assessment of response in patients with hepatic metastases of gastrointestinal
origin. Methods: This study was carried out by cooperation between Clinical Oncology and Nuclear Medicine and
Radiodiagnosis Departments, Faculty of Medicine, Menoufia University. During the period from April 2015 to December
2016 forty patients with stage IV gastrointestinal cancers with hepatic metastases were included, CECT was done
before and after systemic treatment, response evaluation was done by RECIST 1.1 and morphology response criteriac.
Results: By RECIST, partial response (PR) observed in 57.5%, stable disease (SD) 22.5% and progressive disease (PD)
in 20% of patients compared to Optimal response 42.5%, incomplete response 35% and no response in 22.5% of patients
by Morphologic response criteria. Regarding survival, patients with PR had median survival of 20 months (95% CI,
17.988 to 22.012months) versus 11 months (95% CI, 1.235 to 8.580 months) in SD or PD by RECIST, (P=.002). while
by morphology response criteria the median overall survival of optimally responded patients 23 months (95% CI, 20.04
to 27.81months) versus 16 months (95% CI, 5.590 to 5.044 months) in patients with incomplete or no morphologic
response (P=.001). Conclusion: Morphologic response criteria are accurate method for assessment of response of
hepatic metastases and correlated well with patients’ survival and better to be incorporated to treatment evaluation.

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