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Computed tomography 21 days after chemotherapy, three‐dimensional estimates of metastatic volume and the need for surgery in patients with germ cell cancer
Author(s) -
Bozcuk H.S.,
Ravi R.,
Turner B.,
Tsetis D.,
Thomas J.M.,
Chan O.,
Reznek R.,
Hendry W.F.,
Oliver R.T.D.
Publication year - 2000
Publication title -
bju international
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.773
H-Index - 148
eISSN - 1464-410X
pISSN - 1464-4096
DOI - 10.1046/j.1464-410x.2000.00864.x
Subject(s) - shrinkage , chemotherapy , medicine , computed tomography , germ cell tumors , radiology , cancer , cisplatin , nuclear medicine , surgery , machine learning , computer science
Objective To assess whether the response visible on computed tomography (CT) 21 days after the first course of chemotherapy in patients with nonseminomatous germ cell tumour predicts the need for surgery and whether three‐dimensional (3D) reconstruction adds to the diagnostic accuracy. Patients and methods CT scans from 52 patients treated with cisplatin‐based chemotherapy were assessed for tumour shrinkage by measuring the changes of a one‐dimensional (1D) measurement of the maximum transverse diameter, and comparing CT scans before, 21 days after the first course and at the end of chemotherapy (1D method). In a subset of patients, using a special formula, the 1D‐derived 2D and 3D shrinkage (2D der and 3D der ) were compared with four other computed or calculated methods (1D, 2D, 3D calc , 3D comp ). Results At day 21, in 32 of 52 patients (62%) there was < 50% tumour shrinkage using the 1D assessment; 21 of them (66%) needed surgery, compared with none of the 20 patients with > 50% tumour shrinkage by day 21 (χ 2 = 22.83, P < 0.001). The 1D method showed significantly less shrinkage than all the other methods but when this was used to derive a 3D shrinkage, assuming the mass to be spherical (3D der ), it was not statistically different from that of 3D comp . Conclusions The assessment of the response from 1D CT scan estimates 21 days after initiating chemotherapy identifies a subgroup of patients who have a high probability of needing surgery. Although expected to be more accurate, the 3D comp estimate of tumour shrinkage was no better than the 3D der estimate.