Revised Modified RECIST Criteria in Malignant Pleural Mesothelioma (Version 1.1): A Step Forward in a Long Race

Our plain-English summary of Revised Modified RECIST Criteria in Malignant Pleural Mesothelioma (Version 1.1): A Step Forward in a Long Race, by A.S. Tsao, G.W. Gladish, R.R. Gill (Journal of Thoracic Oncology, 2018).

The study

• Authors: A.S. Tsao, G.W. Gladish, R.R. Gill
• Journal: Journal of Thoracic Oncology
• Published: 2018;13(7):871-873
• Type of article: Editorial, Comment
• Cited by: 13 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Summary of the article

In this editorial, the authors commented on a paper by Armato and Nowak, published in the same issue, that proposed version 1.1 of the modified RECIST criteria for measuring tumour response in malignant pleural mesothelioma. They noted that the original modified RECIST of 2004, which used six perpendicular measurements of the pleural rind taken from three CT sections, was an improvement over RECIST, but that measurement variability and imprecision remained. They agreed with lowering the minimum measurable pleural disease from 10 mm to 7 mm and the default size in treatment responders from 5 mm to 2 mm. They noted, however, a potential 10% to 15% measurement variability at this size, and that a 2 mm default would be inconsistent with the 5 mm default in RECIST 1.1. They supported the recommendations for consistent measurement practice and for aligning nonpleural and lymph node measurements with RECIST 1.1. They disagreed on four points: the requirement that measurements be taken on the same three sections; the narrow preferred measurement area between the aortic arch and the left atrium, for which they proposed the carina and superior pulmonary veins as landmarks instead; combining both hemithoraces as one organ in bilateral disease, where they recommended treating the contralateral pleura as a metastatic site; and the unclear definition of progressive disease. They concluded that the proposals needed validation in an independent data set and a multicentre consensus before clinical use, and that the future lay in volumetric quantification.

PubMed has no abstract for this study, and the article doesn't print one. We wrote this summary from the full article with the help of AI. It is not the authors' wording.

In plain English

This editorial reports no new patient data. The authors commented on Armato and Nowak's proposed version 1.1 of the modified RECIST criteria. These criteria measure malignant pleural mesothelioma on CT scans to judge treatment response. They agreed with lowering the minimum measurable baseline pleural disease from 10 mm to 7 mm, and the minimum default size in treatment responders from 5 mm to 2 mm. They noted concern about measurement consistency at the 2 mm size, given a potential 10% to 15% variability. They disagreed on four points. They wanted more flexibility in which CT sections are measured and broader guidance on where to measure. They noted that opposite-side pleural disease is considered a metastatic site except in bilateral synchronous involvement, and recommended measuring it separately from the main tumor. They also wanted a clearer definition of disease progression. The authors concluded that areas of controversy should be addressed before the updates are accepted into clinical practice. They added that any update needs validation in an independent data set and a multi-center consensus guideline.

We wrote this plain-English summary from the full article with the help of AI, and a second AI model checked each sentence against the article. It is not the authors' wording; the abstract and the article are their own account.

What the study did and found

• Design: editorial (opinion commentary on another article; no original data)
• Who was studied: No study population; the editorial comments on a proposal by Armato and Nowak to revise modified RECIST criteria for malignant pleural mesothelioma
• Main results:
  • The authors agreed that the minimum baseline measurable pleural disease should be redefined from 10 mm to 7 mm, and that in treatment responders the minimum default size should go from 5 mm to 2 mm
  • Right after the 5 mm to 2 mm proposal for treatment responders, the authors acknowledged concern over measurement consistency at this small size, given a potential 10% to 15% variability
  • The authors called for more flexibility in the requirement that pleural measurements be taken on the same three CT sections
  • The authors disagreed with the proposed preferred location for measurements, noting that in many patients only about 3 to 4 cm separates the aortic arch and left atrium
  • The authors viewed combining measurements from both sides of the chest as a single organ as highly problematic. They noted that disease in the opposite pleura is considered a site of metastases except in cases of bilateral synchronous involvement, and recommended measuring it separately as a different organ
  • On progressive disease, the authors advised that a new focus of pleural thickening must exceed the 7 mm minimum baseline measurable size, and suggested a minimum increase of 5 mm
  • The authors stated that any proposed update needs validation and comparison with modified RECIST version 1.0 in an independent data set
• The authors' conclusion: The authors concluded that there are significant areas of controversy that should be addressed before the proposed updates can be accepted into clinical practice, and that a multi-center consensus panel guideline is needed

Topics

The National Library of Medicine indexes this study under subjects our site covers: Lung cancer, Mesothelioma.

Medical terms in this study, explained in our Lexicon: Modified RECIST (mRECIST), Pleural Mesothelioma, Bilateral, Contralateral Pleura.

Related studies

• Revised Modified Response Evaluation Criteria in Solid Tumors for Assessment of Response in Malignant Pleural Mesothelioma (Version 1.1) — S.G. Armato, A.K. Nowak (2018)
• A practical guide of the Southwest Oncology Group to measure malignant pleural mesothelioma tumors by RECIST and modified RECIST criteria — A.S. Tsao, L. Garland, et al. (2011)
• A practical guide to measure "all" malignant pleural mesothelioma tumors by modified RECIST criteria? — K. Nackaerts, J. Vansteenkiste, et al. (2011)
• Metabolic response assessment with 18F-FDG-PET/CT is superior to modified RECIST for the evaluation of response to platinum-based doublet chemotherapy in malignant pleural mesothelioma — S. Kanemura, K. Kuribayashi, et al. (2017)
• Comparison of modified Response Evaluation Criteria in Solid Tumors, European Organization for Research and Treatment of Cancer criteria, and PET Response Criteria in Solid Tumors for evaluation of tumor response to chemotherapy and prognosis prediction in patients with unresectable malignant pleural mesothelioma — K. Kitajima, M. Maruyama, et al. (2020)
• Combination raltitrexed (Tomudex(R))-oxaliplatin: a step forward in the struggle against mesothelioma? The Institut Gustave Roussy experience with chemotherapy and chemo-immunotherapy in mesothelioma — K. Fizazi, R. Caliandro, et al. (2000)

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