Comparison of Choi criteria and Response Evaluation Criteria in Solid Tumors (RECIST) for intrahepatic cholangiocarcinoma treated with glass-microspheres Yttrium-90 selective internal radiation therapy (SIRT). Issue 8 (August 2016) - Beuzit, Luc
Highlights: After selective internal radiation therapy in intrahepatic cholangiocarcinoma, Choi criteria better identify patients with long survival than RECIST. Choi criteria should be used for the assessment of treatment efficacy in this situation. The decrease of density in the treated lesions is a more sensitive prognostic criteria than the change of size. Abstract: Objective: To compare Choi criteria with Response Evaluation Criteria in Solid Tumors (RECIST) for the prediction of overall survival (OS) in patients treated with glass-microspheres, Yttrium‐90 selective internal radiation therapy (SIRT) for intrahepatic cholangiocarcinoma (ICC). Methods: Between 2010 and 2014, 45 adult patients with locally advanced ICC treated with SIRT were retrospectively analyzed. Computed tomography scans performed before and after treatment were analyzed using both RECIST 1.1 and Choi criteria. Response was correlated with survival. Results: Patients who achieved an objective response according to Choi had a longer OS than non-responders (median OS 19.9 months [95% CI, 1.1–38.7 months] vs. 7.5 months if stable disease [uncountable CI] and 3 months if progressive disease [95% CI, 0–6.2 months], log-rank test: p = 0.003) whereas there was no significant survival difference according to the RECIST response ( p = 0.339). Among the 39 RECIST non-responding patients, those identified as responders by Choi (n = 31) had significantly better OS than Choi non-responders (median OS 19.9 months (95% CI, 5.1–34.7 months) and 5.4 months (95% CI, 0–11.6 months), p = 0.005). Conclusions: Choi criteria appear more appropriate than RECIST to identify responders with long survival among patients who received SIRT for ICC.