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    Patent Pending

    Modified Response Evaluation Criteria in Solid Tumors (mRECIST)

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

    Result:

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    Next Steps
    Evidence
    Creator Insights

    Advice

    • Contrast-enhanced CT or MRI is the imaging modality of choice for evaluating lesions.
    • European Association for the Study of the Liver (EASL) guidelines recommend evaluating for mRECIST criteria 1 month after undergoing treatment (surgery, locoregional therapy or initiation of systemic chemotherapy).

    Management

    recist treatment hcc
     
    CR, complete response. PR, partial response. SD, stable disease. PD, progressive disease. IR, incomplete response.

    Formula

    Responses are defined as the following (RECIST is listed for comparison):

     

    RECIST

    mRECIST

    Complete response

    Disappearance of all target lesions

    Disappearance of any intratumoral arterial enhancement in all target lesions

    Partial response

    At least a 30% decrease in the sum of diameters of target lesions, taking as reference the baseline sum of the diameters of target lesions

     At least a 30% decrease in the sum of diameters of viable (enhancement in the arterial phase) target lesions, taking as reference the baseline sum of the diameters of target lesions

    Stable disease

    Any cases that do not qualify for either partial response or progressive disease

    Any cases that do not qualify for either partial response or progressive disease

    Progressive disease

    An increase of at least 20% in the sum of the diameters of target lesions, taking as reference the smallest sum of the diameters of target lesions recorded since treatment started

    An increase of at least 20% in the sum of the diameters of viable (enhancing) target lesions, taking as reference the smallest sum of the diameters of viable (enhancing) target lesions recorded since treatment started

    Evidence Appraisal

    • The modified Response Evaluation Criteria in Solid Tumors (mRECIST) was developed in 2008 by the American Association for the Study of Liver Disease (AASLD) as an amended version of the RECIST, a method of measuring tumor response to treatment. mRECIST was developed specifically for HCC.
    • Llovet and colleagues in 2008 developed a framework for design of clinical trials in HCC, which included mRECIST. The original RECIST was developed in 1981 by Miller et al and did not account for measures of tumor activity other than size.
    • Both RECIST and mRECIST are criteria developed from expert consensus and, though widely used, have not been validated against the gold standard of pathologic studies of explanted livers.

    Literature

    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