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Poster display session

3166 - Correlation between RECIST-criteria, Morphologic Response by CT and Pathologic Regression in Hepatic Metastasis Secondary to Colorectal Cancer: The AVAMET study


09 Sep 2017


Poster display session


Colon and Rectal Cancer


Ruth Vera


Annals of Oncology (2017) 28 (suppl_5): v158-v208. 10.1093/annonc/mdx393


R. Vera1, M. Gómez2, J.R. Ayuso3, J. Figueras4, P. Garcia-Alfonso5, V. Martinez6, A. Lacasta7, A. Ruiz8, M.J. Safont9, J. Aparicio10, J. Campos11, J. Cámara12, M. Martin13, C. Montagut14, C. Pericay15, J.M. Viéitez16, E. Falcó17, M. Jorge18, M. Marín Vera19, M. Salgado Fernandez20

Author affiliations

  • 1 Medical Oncology, Complejo Hospitalario de Navarra, 31008 - Pamplona/ES
  • 2 Pathology, Complejo Hospitalario de Navarra, 31190 - Pamplona/ES
  • 3 Radiodiagnostic, Hospital Clinic, Barcelona/ES
  • 4 Surgey, Hospital Josep Trueta, Gerona/ES
  • 5 Medical Oncology, Hospital Universitario Gregorio Marañón, Madrid/ES
  • 6 Medical Oncology, Hospital La Paz, Madrid/ES
  • 7 Medical Oncology, Hospital Donostia, San Sabastian/ES
  • 8 Medical Oncology, Hospital Puerta de Hierro, Madrid/ES
  • 9 Medical Oncology, Hospital General de Valencia, Valencia/ES
  • 10 Medical Oncology, Hospital Universitario y Politécnico La Fe, Valencia/ES
  • 11 Medical Oncology, Hospital Arnau de Vilanova, Valencia/ES
  • 12 Medical Oncology, Hospital Fundacion Alcorcón, Madrid/ES
  • 13 Medical Oncology, Hospital de La Santa Creu i Sant Pau, Sant Pau/ES
  • 14 Medical Oncology, University Hospital del Mar, 8003 - Barcelona/ES
  • 15 Medical Oncology, Hospital de Sabadell Corporacis Parc Tauli, 8208 - Sabadell/ES
  • 16 Medical Oncology, Hospital Universitario Central de Asturias, 33011 - Oviedo/ES
  • 17 Medical Oncology, Hospital Son Llatzer, Palma de Mallorca/ES
  • 18 Medical Oncology, Complexo Hospitalario Xeral Cies, Vigo/ES
  • 19 Medical Oncology, Hospital Universitario Virgen de la Arrixaca, 30120 - Murcia/ES
  • 20 Medical Oncology, Complejo Hospitalario De Ourense, 32005 - Ourense/ES


Abstract 3166


The RECIST criteria may be limited in assessing response to biologic agents such as bevacizumab (BVZ). Computed tomography-based morphologic criteria (CTMC) might be an alternative to evaluate response in these cases. The aim of this trial was to evaluate the correlation of overall objective responses evaluated by RECIST with CTMC and the pathologic response (pR) after the resection of liver metastases from colorectal cancer.


Patients with ≤ 4 resectable CLM, with no prior chemotherapy for metastatic disease, received 3 cycles of capecitabine/oxaliplatin (XELOX)+BVZ. Response was evaluated using RECIST criteria and CTMC. For CTMC, metastasis was assigned to 1 of 3 groups (Table): CTMC were defined as optimal (metastasis changed from a group 3 or 2 to a 1), incomplete (group changed from 3 to 2), and none (the group had not changed or increased). Those patients without progression, received another cycle of XELOX prior to surgery. After surgery, BVZ + XELOX was given for up to 4 additional cycles. pR was scored as minor (≥50% of residual tumor cells), major (1-49% residual tumor cells), and complete (no residual tumor cells detected).Table:


Computed Tomographic Morphologic Groups
Computed Tomographic Tumor Characteristics
Morphology GroupOverall AttenuationTumor-Liver InterfacePeripheral Rim of enhancement
3HeterogeneousIll definedMay be present
2MixedVariableIf initially present, partially resolved
1Homogeneous and hypoattenuatingSharpIf initially present, completely resolved


83 patients were recruited. 68 were evaluated by RECIST and 67 of them by CTMC; 60 underwent surgery, 51 with metastases resection and histologically analysis. 33 of 68 pts reached partial response by RECIST (49%, 95%CI 37-60%) and 58 had optimal (26) or incomplete (32) response by CTMC (85%, 95%CI 75-92%). Complete (12) or major (30) pR was achieved in 42 of 51 pts (82%, 95%CI 70-90%). Although there was no correlation between the RECIST criteria, CTMC and pR, CTMC was more specific for predicting complete/major pR than RECIST (36 of 42, CTMC vs. 24 of 42, RECIST, p=.0038). In patients with liver resection overall survival at 48 months was 65.8%.


CTMC was more specific for predicting complete/major pR than RECIST criteria. After liver metastases resection, 82% of patients had complete or major pR. CTMC seem to be a better surrogate marker of objective pR than RECIST.

Clinical trial identification


Legal entity responsible for the study





All authors have declared no conflicts of interest.

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