Tumor response assessment: comparison between unstructured free text reporting in routine clinical workflow and computer-aided evaluation based on RECIST 1.1 criteria

Abstract

Purpose:
Standardized computer-aided tumor response assessment is common in clinical trials. In contrast, unstructured free text reporting (UFTR) is common in daily routine. Therefore, this study aimed to discern and quantify differences between UFTR and computer-aided standardized tumor response evaluation based on RECIST 1.1 criteria (RECIST), serving as gold standard, in clinical workflow.

Methods:
One-hundred consecutive patients with cancer eligible for RECIST 1.1 evaluation, who received five follow-up CTs of the trunk, were retrospectively included. All UFTRs were assigned to RECIST response categories [complete response, partial response (PR), stable disease (SD), progressive disease (PD)]. All CTs were re-evaluated using dedicated software (mint lesion™) applying RECIST 1.1. The accordance in tumor response ratings was analyzed using Cohen's kappa.

Results:
At the first follow-up, 47 cases were rated differently with an SD underrepresentation and a PR and PD overrepresentation in UFTR. In the subsequent follow-ups, categorical differences were seen in 38, 44, 37, and 44%. Accordance between UFTR and RECIST was fair to moderate (Cohen's kappa: 0.356, 0.477, 0.390, 0.475, 0.376; always p < 0.001). Differences were mainly caused by the rating of even small tumor burden changes as PD or PR in UFTR or by comparison to the most recent prior CT scan in UFTR instead of comparison to nadir or baseline.

Conclusions:
Significant differences in tumor response ratings were detected comparing UFTR and computer-aided standardized evaluation based on RECIST 1.1. Thus, standardized reporting should be implemented in daily routine workflow.

Full text

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J Cancer Res Clin Oncol (2017) 143:2527–2533
DOI 10.1007/s00432-017-2488-1
ORIGINAL ARTICLE – CLINICAL ONCOLOGY
Tumor response assessment: comparison betweenunstructured
free text reporting inroutine clinical workflow
andcomputer‑aided evaluation based onRECIST 1.1 criteria
JulianeGoebel1 · JuliaHoischen2· CarolinGramsch3· HaemiP.Schemuth1·
Andreas‑ClaudiusHoffmann4· LaleUmutlu1· KaiNassenstein1
Received: 7 May 2017 / Accepted: 1 August 2017 / Published online: 19 August 2017
© Springer-Verlag GmbH Germany 2017
moderate (Cohen’s kappa: 0.356, 0.477, 0.390, 0.475, 0.376;
always p<0.001). Differences were mainly caused by the
rating of even small tumor burden changes as PD or PR in
UFTR or by comparison to the most recent prior CT scan in
UFTR instead of comparison to nadir or baseline.
Conclusions Significant differences in tumor response rat-
ings were detected comparing UFTR and computer-aided
standardized evaluation based on RECIST 1.1. Thus, stand-
ardized reporting should be implemented in daily routine
workflow.
Keywords Oncologic imaging· Radiological tumor
response assessment· RECIST 1.1 criteria·
Cross-sectional imaging· Solid tumors
Introduction
The assessment of tumor burden change is important in
the evaluation of cancer therapeutics in clinical trials as
well as in therapy monitoring in daily clinical routine.
The use of tumor shrinkage as an objective parameter for
tumor response in cancer therapy is based on the evidence
that for many solid tumors, a decrease in tumor burden is
associated with an improved patient survival (Paesmans
etal. 1997; Buyse etal. 2000; El-Maraghi and Eisenhauer
2008) and the fact that clinical symptoms may often be
misleading especially in advanced solid tumors or in
aggressive therapy regimens. Other surrogate markers like
serum tests (so-called tumor markers, C-reactive protein,
lactate dehydrogenase) may be useful (Fang etal. 2015;
Scartozzi etal. 2012); however, the objective change in
tumor burden is considered to be the backbone of deci-
sion making in clinical trials as well as in clinical routine.
Cross-sectional imaging either by computed tomography
Abstract
Purpose Standardized computer-aided tumor response
assessment is common in clinical trials. In contrast, unstruc-
tured free text reporting (UFTR) is common in daily rou-
tine. Therefore, this study aimed to discern and quantify
differences between UFTR and computer-aided standardized
tumor response evaluation based on RECIST 1.1 criteria
(RECIST), serving as gold standard, in clinical workflow.
Methods One-hundred consecutive patients with can-
cer eligible for RECIST 1.1 evaluation, who received five
follow-up CTs of the trunk, were retrospectively included.
All UFTRs were assigned to RECIST response categories
[complete response, partial response (PR), stable disease
(SD), progressive disease (PD)]. All CTs were re-evaluated
using dedicated software (mint lesion™) applying RECIST
1.1. The accordance in tumor response ratings was analyzed
using Cohen’s kappa.
Results At the first follow-up, 47 cases were rated dif-
ferently with an SD underrepresentation and a PR and PD
overrepresentation in UFTR. In the subsequent follow-
ups, categorical differences were seen in 38, 44, 37, and
44%. Accordance between UFTR and RECIST was fair to
* Juliane Goebel
Juliane.Goebel@uk-essen.de
1 Department ofDiagnostic andInterventional Radiology
andNeuroradiology, University Hospital Essen,
Hufelandstrasse 55, 45122Essen, Germany
2 Department ofRadiology, Evangelic Hospital Duesseldorf,
Duesseldorf, Germany
3 Institute forNeuroradiology, University Hospital Giessen,
Giessen, Germany
4 Department ofOncology andHematology, Helios Hospital
Ahrenshoop, Ahrenshoop, Germany
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