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    Attention COACH STUDY participants:

    The principal investigators of the study request that you use the official version of the modified score here.

    Modified Response Evaluation Criteria in Solid Tumors (mRECIST)

    Measures treatment response, specifically to cytotoxic drugs, based on tumor shrinkage.

    INSTRUCTIONS

    Use in liver lesions meeting the following criteria:

    • Can be accurately measured in at least one dimension as 10 mm or more (measure longest diameter).
    • Suitable for repeat measurement.
    • Intratumoral arterial enhancement on contrast-enhanced CT or MRI.
    When to Use
    Pearls/Pitfalls
    Why Use

    Patients with hepatocellular carcinoma (HCC) who have undergone treatment (systemic, locoregional, and/or surgical).

    • Can identify patients who are not responding to therapy, in order to help guide decisions about modification of therapy, more quickly than traditional endpoints like morbidity and mortality.
    • Tumor response, while an important surrogate for efficacy of cancer treatment, is not equivalent to overall survival.
    • Specific to HCC, unlike the original RECIST.
    • Based on expert consensus and not yet validated against gold standard (pathologic examination of explanted livers), though widely used.
    • HCC patients undergo complex multimodal therapies, including systemic cytotoxic chemotherapy, targeted therapy like sorafenib, locoregional treatment like transarterial chemoembolization (TACE) and radioembolization with Y90), and surgical resection. Imaging criteria (versus traditional endpoints of morbidity and mortality) can more quickly identify patients who are not responding to therapy to help guide decisions about modification of therapy.
    • Offers improved accuracy over previous criteria for tumor response (WHO and RECIST), which were developed based on data from patients receiving cytotoxic chemotherapy only.
    • Accounts for tumor necrosis induced by treatment (which can be misinterpreted as living tumor by WHO classification).
    mm
    mm

    Diagnostic Result:

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    Next Steps
    Evidence
    Creator Insights
    Dr. Josep Llovet

    About the Creator

    Josep Llovet, MD, is a professor of medicine and founder and director of the Liver Cancer Program at Mount Sinai Hospital. He was the president, secretary and founder of the International Liver Cancer Association (ILCA) and Chairman of the European Clinical Practice Guidelines of management of liver cancer (EASL-EORTC). He is an active researcher investigating the pathogenesis and treatment of liver cancer.

    To view Dr. Josep Llovet's publications, visit PubMed

    Are you Dr. Josep Llovet? Send us a message to review your photo and bio, and find out how to submit Creator Insights!
    MDCalc loves calculator creators – researchers who, through intelligent and often complex methods, discover tools that describe scientific facts that can then be applied in practice. These are real scientific discoveries about the nature of the human body, which can be invaluable to physicians taking care of patients.
    About the Creator
    Dr. Josep Llovet
    Are you Dr. Josep Llovet?