medvisМедицинская визуализацияMedical Visualization1607-07632408-9516RDS-Media Ltd.medvis-289Research ArticleПОВЕРХНОСТНЫЕ ОРГАНЫSUPERFICIAL ORGANSМетастазы рака молочной железы в печень после химиоэмболизации печеночной артерии: новые критерии оценки объективного ответаBreast Cancer Hepatic Metastases after Transarterial Chemoembolization: the New Objective Response CriteriaПоповАндрей АлександровичPopovAndrey Alexandrovichdronetz@yandex.ruПолярушНаталья ФедоровнаPolyarushNatalya Fedorovnanoemail@neicon.ruКозупицаГеннадий СтепановичKozupitsaGennady Stepanovichnoemail@neicon.ruГБУЗ “Самарский областной клинический онкологический диспансер”РоссияSamara Regional Clinical Oncology CentreRussian FederationЧУ ООВО Медицинский университет “Реавиз”РоссияMedical University “Reaviz”Russian FederationООО Центр медицины и валеологии “Литтл”РоссияCentre of Medicine and Valeology “Little”Russian Federation20162806201603125135Copyright © Попов А.А., Поляруш Н.Ф., Козупица Г.С., 20162016Попов А.А., Поляруш Н.Ф., Козупица Г.С.Popov A.A., Polyarush N.F., Kozupitsa G.S.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://medvis.rdsmedia.ru/jour/article/view/289

Цель исследования: разработка критериев оценки эффективности лечения метастазов рака молочной железы в печень методом химиоэмболизации печеночной артерии, основанных на расчете изменения объема опухолевой ткани в метастатических очагах, и сравнение полученных критериев с критериями RECIST Материал и методы. Проанализированы данные компьютерной томографии, проведенной до и после лечения у 21 больной с метастатическим поражением печени. Результаты лечения оценивались для каждого пациента согласно критериям RECIST и показателю кинетики роста опухоли (величина, обратная времени удвоения, RDT). Проводился сравнительный анализ данных объективного ответа, определенного двумя названными способами. Результаты. Отмечены статистически значимые лучшие показатели общей и безрецидивной выживаемости в группе пациентов с объективным ответом по показателю RDT Полученные результаты свидетельствуют о том, что применение критериев RECIST может привести к недооценке объективного ответа на лечение. Выводы. Предложенные критерии ответа, основанные на показателях кинетики роста опухоли, представляются более точными и адекватно отвечающими как характеру морфологических изменений в очаге, так и динамике развития заболевания.

Objective: to evaluate the effect of transarterial chemoembolization (TACE) of breast cancer hepatic metastases, based on the calculation of changes in the volume of tumor tissue in metastatic lesions, and comparing this criteria with the RECIST criteria. Materials and methods. CT data of 21 patients with breast cancer metastatic liver lesions before and after treatment was analyzed. Evaluation of the treatment results was made separately for each patient according to RECIST criteria and according to criteria based on the indicator of tumor growth kinetics (reciprocal of doubling time, RDT). Comparative analysis of different criteria was conducted. Results. There was a statistically significant better performance of overall and disease-free survival in patients with an objective response by RDT indicator. The results indicate that the use of RECIST criteria may underestimate the objective response to treatment. Conclusion. The proposed tumor response evaluation criteria, based on the analysis of tumor growth kinetics, proves to be more accurate and respond adequately to the nature of morphological changes in the lesion and to the disease dynamics as well.

рак молочной железыметастазы в печеньхимиоэмболизация печеночной артериикомпьютерная томографияRECISTbreast cancerhepatic metastasestransarterial hepatic chemoembolizationcomputed tomographyRECISTReferencesАксель Е.М., Михайлов Э.А. Статистика рака молочной железы в Москве. Вопросы онкологии. 2005; 51 (6): 656-658.Аксель Е.М., Михайлов Э.А. Статистика рака молочной железы в Москве. Вопросы онкологии. 2005; 51 (6): 656-658.Elias D., Lasser P., Spielmann M. et al. Surgical and chemotherapeutic treatment of hepatic metastases from carcinoma of the breast. Surg. Gynecol. Obstet. 1991; 172 (6): 461-464.Elias D., Lasser P., Spielmann M. et al. Surgical and chemotherapeutic treatment of hepatic metastases from carcinoma of the breast. Surg. Gynecol. Obstet. 1991; 172 (6): 461-464.Diaz R., Santaballa A., Munarriz B. et al. Hepatic resection in breast cancer metastases: should it be considered standard treatment? Breast. 2004; 13 (3): 254-258.Diaz R., Santaballa A., Munarriz B. et al. Hepatic resection in breast cancer metastases: should it be considered standard treatment? Breast. 2004; 13 (3): 254-258.Аксель Е.М. Смертность населения России и стран СНГ от злокачественных новообразований в 2008 году. Вестник РОНЦ им. Н.Н. Блохина. 2011; 22 (3): 93-123.Аксель Е.М. Смертность населения России и стран СНГ от злокачественных новообразований в 2008 году. Вестник РОНЦ им. Н.Н. Блохина. 2011; 22 (3): 93-123.Kostov D.V., Kobakov G.L., Yankov D.V. Prognostic factors related to surgical outcome of liver metastases of breast cancer. J. Breast. Cancer. 2013; 16 (2): 184-192.Kostov D.V., Kobakov G.L., Yankov D.V. Prognostic factors related to surgical outcome of liver metastases of breast cancer. J. Breast. Cancer. 2013; 16 (2): 184-192.Giroux M.F., Baum R.A., Soulen M.C. Chemoembolization of liver metastasis from breast carcinoma. J. Vasc. Interv. Radiol. 2004; 15 (3): 289-291.Giroux M.F., Baum R.A., Soulen M.C. Chemoembolization of liver metastasis from breast carcinoma. J. Vasc. Interv. Radiol. 2004; 15 (3): 289-291.Buijs M., Kamel I.R., Vossen J.A. et al. Assessment of metastatic breast cancer response to chemoembolization with contrast agent enhanced and diffusion-weighted MR imaging. J. Vasc. Interv. Radiol. 2007; 18 (8): 957-963.Buijs M., Kamel I.R., Vossen J.A. et al. Assessment of metastatic breast cancer response to chemoembolization with contrast agent enhanced and diffusion-weighted MR imaging. J. Vasc. Interv. Radiol. 2007; 18 (8): 957-963.Vogl T.J., Naguib N.N., Nour-Eldin N.E. et al. Transarterial chemoembolization (TACE) with mitomycin C and gemcitabine for liver metastases in breast cancer. Eur. Radiol. 2010; 20 (1): 173-180.Vogl T.J., Naguib N.N., Nour-Eldin N.E. et al. Transarterial chemoembolization (TACE) with mitomycin C and gemcitabine for liver metastases in breast cancer. Eur. Radiol. 2010; 20 (1): 173-180.Vogl T.J., Naguib N.N., Nour-Eldin N.E. et al. Repeated chemoembolization followed by laser-induced thermotherapy for liver metastasis of breast cancer. Am. J. Roentgenol. 2011; 196 (1): 66-72.Vogl T.J., Naguib N.N., Nour-Eldin N.E. et al. Repeated chemoembolization followed by laser-induced thermotherapy for liver metastasis of breast cancer. Am. J. Roentgenol. 2011; 196 (1): 66-72.Силантьева Н.К., Агабабян Т.А., Березовская Т.П. и др. КТ-оценка эффектов химио- и лучевой терапии злокачественных опухолей. Медицинская визуализация. 2014; 6: 59-74.Силантьева Н.К., Агабабян Т.А., Березовская Т.П. и др. КТ-оценка эффектов химио- и лучевой терапии злокачественных опухолей. Медицинская визуализация. 2014; 6: 59-74.Eisenhauer E.A., Therasse P., Bogaerts J. et al. New response evaluation criteria in solid tumours: revised RECIST guideline (version 1.1). Eur. J. Cancer. 2009; 45 (2): 228-247.Eisenhauer E.A., Therasse P., Bogaerts J. et al. New response evaluation criteria in solid tumours: revised RECIST guideline (version 1.1). Eur. J. Cancer. 2009; 45 (2): 228-247.Suzuki C., Blomqvist L., Hatschek T. et al. Impact of the first tumor response at eight weeks on overall survival in metastatic breast cancer patients treated with first-line combination chemotherapy. Med. Oncol. 2013; 30 (1): 415.Suzuki C., Blomqvist L., Hatschek T. et al. Impact of the first tumor response at eight weeks on overall survival in metastatic breast cancer patients treated with first-line combination chemotherapy. Med. Oncol. 2013; 30 (1): 415.Rezai P., Mulcahy M.F., Tochetto S.M. et al. Morphological analysis of pancreatic adenocarcinoma on multidetector row computed tomography: implications for treatment response evaluation. Pancreas. 2009; 38 (7): 799-803.Rezai P., Mulcahy M.F., Tochetto S.M. et al. Morphological analysis of pancreatic adenocarcinoma on multidetector row computed tomography: implications for treatment response evaluation. Pancreas. 2009; 38 (7): 799-803.Galizia M.S., Töre H.G., Chalian H. et al. Evaluation of hepatocellular carcinoma size using two-dimensional and volumetric analysis: effect on liver transplantation eligibility. Acad. Radiol. 2011; 18 (12): 1555-1560.Galizia M.S., Töre H.G., Chalian H. et al. Evaluation of hepatocellular carcinoma size using two-dimensional and volumetric analysis: effect on liver transplantation eligibility. Acad. Radiol. 2011; 18 (12): 1555-1560.Michaelis L.C., Ratain M.J. Measuring response in a post-RECIST world: from black and white to shades of grey. Nat. Rev. Cancer. 2006; 6 (5): 409-414.Michaelis L.C., Ratain M.J. Measuring response in a post-RECIST world: from black and white to shades of grey. Nat. Rev. Cancer. 2006; 6 (5): 409-414.Forner A., Ayuso C., Varela M. et al. Evaluation of tumor response after locoregional therapies in hepatocellular carcinoma: are response evaluation criteria in solid tumors reliable? Cancer. 2009; 115 (3): 616-623.Forner A., Ayuso C., Varela M. et al. Evaluation of tumor response after locoregional therapies in hepatocellular carcinoma: are response evaluation criteria in solid tumors reliable? Cancer. 2009; 115 (3): 616-623.Mehrara E., Forssell-Aronsson E., Ahlman H. et al. Quantitative analysis of tumor growth rate and changes in tumor marker level: specific growth rate versus doubling time. Acta. Oncol. 2009; 48 (4): 591-597.Mehrara E., Forssell-Aronsson E., Ahlman H. et al. Quantitative analysis of tumor growth rate and changes in tumor marker level: specific growth rate versus doubling time. Acta. Oncol. 2009; 48 (4): 591-597.Rezai P., Yaghmai V., Tochetto S.M. et al. Change in the growth rate of localized pancreatic adenocarcinoma in response to gemcitabine, bevacizumab, and radiation therapy on MDCT. Int. J. Radiat. Oncol. Biol. Phys. 2011; 81 (2): 452-459.Rezai P., Yaghmai V., Tochetto S.M. et al. Change in the growth rate of localized pancreatic adenocarcinoma in response to gemcitabine, bevacizumab, and radiation therapy on MDCT. Int. J. Radiat. Oncol. Biol. Phys. 2011; 81 (2): 452-459.Takayasu K., Moriyama N., Muramatsu Y. et al. Hepatic arterial embolization for hepatocellular carcinoma. Comparison of CT scans and resected specimens. Radiology. 1984; 150 (3): 661-665.Takayasu K., Moriyama N., Muramatsu Y. et al. Hepatic arterial embolization for hepatocellular carcinoma. Comparison of CT scans and resected specimens. Radiology. 1984; 150 (3): 661-665.Takayasu K., Arii S., Matsuo N. et al. Comparison of CT findings with resected specimens after chemoembolization with iodized oil for hepatocellular carcinoma. Am. J. Roentgenol. 2000; 175 (3): 699-704.Takayasu K., Arii S., Matsuo N. et al. Comparison of CT findings with resected specimens after chemoembolization with iodized oil for hepatocellular carcinoma. Am. J. Roentgenol. 2000; 175 (3): 699-704.Schwartz M. A biomathematical approach to clinical tumor growth. Cancer. 1961; 14: 1272-1294.Schwartz M. A biomathematical approach to clinical tumor growth. Cancer. 1961; 14: 1272-1294.Zhang J., Kang S.K., Wang L. et al. Distribution of renal tumor growth rates determined by using serial volumetric CT measurements. Radiology. 2009; 250 (1): 137-144.Zhang J., Kang S.K., Wang L. et al. Distribution of renal tumor growth rates determined by using serial volumetric CT measurements. Radiology. 2009; 250 (1): 137-144.Keil S., Plumhans C., Behrendt F.F. et al. Semi-automated quantification of hepatic lesions in a phantom. Invest. Radiol. 2009; 44 (2): 82-88.Keil S., Plumhans C., Behrendt F.F. et al. Semi-automated quantification of hepatic lesions in a phantom. Invest. Radiol. 2009; 44 (2): 82-88.Gonzalez-Guindalini F.D., Botelho M.P. et al. Assessment of liver tumor response to therapy: role of quantitative imaging. Radiographics. 2013; 33 (6): 1781-1800.Gonzalez-Guindalini F.D., Botelho M.P. et al. Assessment of liver tumor response to therapy: role of quantitative imaging. Radiographics. 2013; 33 (6): 1781-1800.Therasse P., Arbuck S.G., Eisenhauer E.A. et al. New guidelines to evaluate the response to treatment in solid tumors. European Organization for Research and Treatment of Cancer, National Cancer Institute of the United States, National Cancer Institute of Canada. J. Natl. Cancer. Inst. 2000; 92 (3): 205-216.Therasse P., Arbuck S.G., Eisenhauer E.A. et al. New guidelines to evaluate the response to treatment in solid tumors. European Organization for Research and Treatment of Cancer, National Cancer Institute of the United States, National Cancer Institute of Canada. J. Natl. Cancer. Inst. 2000; 92 (3): 205-216.Tran L.N., Brown M.S., Goldin J.G. et al. Comparison of treatment response classifications between unidimensional, bidimensional, and volumetric measurements of metastatic lung lesions on chest computed tomography. Acad. Radiol. 2004; 11 (12): 1355-1360.Tran L.N., Brown M.S., Goldin J.G. et al. Comparison of treatment response classifications between unidimensional, bidimensional, and volumetric measurements of metastatic lung lesions on chest computed tomography. Acad. Radiol. 2004; 11 (12): 1355-1360.Heussel C.P., Meier S., Wittelsberger S. et al. Follow-up CT measurement of liver malignoma according to RECIST and WHO vs. volumetry. Röfo. 2007; 179 (9): 958-964.Heussel C.P., Meier S., Wittelsberger S. et al. Follow-up CT measurement of liver malignoma according to RECIST and WHO vs. volumetry. Röfo. 2007; 179 (9): 958-964.Baghi M., Bisdas S., Engels K. et al. Prognostic relevance of volumetric analysis in tumour specimens of hypopharyngeal cancer. Clin. Otolaryngol. 2007; 32 (5): 372-377.Baghi M., Bisdas S., Engels K. et al. Prognostic relevance of volumetric analysis in tumour specimens of hypopharyngeal cancer. Clin. Otolaryngol. 2007; 32 (5): 372-377.Lee S.M., Kim S.H., Lee J.M. et al. Usefulness of CT volumetry for primary gastric lesions in predicting pathologic response to neoadjuvant chemotherapy in advanced gastric cancer. Abdom. Imaging. 2009; 34 (4): 430-440.Lee S.M., Kim S.H., Lee J.M. et al. Usefulness of CT volumetry for primary gastric lesions in predicting pathologic response to neoadjuvant chemotherapy in advanced gastric cancer. Abdom. Imaging. 2009; 34 (4): 430-440.Seyal A.R., Parekh K., Velichko Y.S. et al. Tumor growth kinetics versus RECIST to assess response to locoregional therapy in breast cancer liver metastases. Acad. Radiol. 2014; 21 (8): 950-957.Seyal A.R., Parekh K., Velichko Y.S. et al. Tumor growth kinetics versus RECIST to assess response to locoregional therapy in breast cancer liver metastases. Acad. Radiol. 2014; 21 (8): 950-957.Ebied O.M., Federle M.P., Carr B.I. et al. Evaluation of responses to chemoembolization in patients with unresectable hepatocellular carcinoma. Cancer. 2003; 97 (4): 1042-1050.Ebied O.M., Federle M.P., Carr B.I. et al. Evaluation of responses to chemoembolization in patients with unresectable hepatocellular carcinoma. Cancer. 2003; 97 (4): 1042-1050.

The authors declare that there are no conflicts of interest present.