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Gastrointestinal Stromal Tumor: A Method for Optimizing the Timing of CT Scans in the Follow-up of Cancer Patients.

Joensuu, Heikki; Reichardt, Peter; Eriksson, Mikael LU ; Hall, Kirsten Sundby and Vehtari, Aki (2014) In Radiology 271(1). p.96-103
Abstract
Purpose To develop a mathematical model to adjust the timing of computed tomography (CT) scans with the hazard of cancer recurrence in time to facilitate early detection of cancer recurrence. Materials and Methods The clinical data were extracted from the randomized Scandinavian Sarcoma Group (SSG) XVIII/Arbeitsgemeinschaft Internistische Onkologie (AIO) trial database. The SSG XVIII/AIO trial was registered (trial no. NCT00116935) and approved by the national or institutional review boards. In the trial, 1- and 3-year durations of adjuvant imatinib mesylate in the treatment of patients with gastrointestinal stromal tumor (GIST) were compared. A nonhomogeneous Poisson model with a piecewise log-constant hazard in time that accounts for the... (More)
Purpose To develop a mathematical model to adjust the timing of computed tomography (CT) scans with the hazard of cancer recurrence in time to facilitate early detection of cancer recurrence. Materials and Methods The clinical data were extracted from the randomized Scandinavian Sarcoma Group (SSG) XVIII/Arbeitsgemeinschaft Internistische Onkologie (AIO) trial database. The SSG XVIII/AIO trial was registered (trial no. NCT00116935) and approved by the national or institutional review boards. In the trial, 1- and 3-year durations of adjuvant imatinib mesylate in the treatment of patients with gastrointestinal stromal tumor (GIST) were compared. A nonhomogeneous Poisson model with a piecewise log-constant hazard in time that accounts for the nonlinear pattern of GIST recurrence was applied to tumor site, mitotic count, and recurrence data. The optimal times to obtain follow-up CT scans were computed by modifying the frequency of CT scans with the hazard of tumor recurrence in time. The hazard-adjusted follow-up schedules were compared with the National Comprehensive Cancer Network (NCCN) guidelines of the United States, which suggest imaging with CT at intervals of 3-6 months for 3-5 years and then annually. Results Optimized timing of CT scans on the basis of hazard of recurrence resulted in follow-up schedule options where CT is performed more sparsely than in the NCCN guidelines during adjuvant imatinib administration and more frequently, at approximately 3-month intervals, during the first 2 years that follow imatinib discontinuation when the risk of recurrence was the greatest. The number of CT scans could be reduced by a median of 31% (from 13 to nine) compared with the standard schedules within the first 6 years of follow-up without increasing the delay in recurrence detection. Conclusion Detection of GIST recurrence may be enhanced by adjusting the timing of the CT scans with the hazard of recurrence. The method may be applicable to other human tumor types. © RSNA, 2013 Online supplemental material is available for this article. (Less)
Please use this url to cite or link to this publication:
author
organization
publishing date
type
Contribution to journal
publication status
published
subject
in
Radiology
volume
271
issue
1
pages
96 - 103
publisher
Radiological Society of North America
external identifiers
  • pmid:24475826
  • wos:000335139200010
  • scopus:84896905830
ISSN
1527-1315
DOI
10.1148/radiol.13131040
language
English
LU publication?
yes
id
03e0d0d2-e3ad-40eb-a3e1-99cf83733b64 (old id 4290503)
alternative location
http://www.ncbi.nlm.nih.gov/pubmed/24475826?dopt=Abstract
date added to LUP
2014-02-09 16:36:49
date last changed
2017-05-28 03:13:41
@article{03e0d0d2-e3ad-40eb-a3e1-99cf83733b64,
  abstract     = {Purpose To develop a mathematical model to adjust the timing of computed tomography (CT) scans with the hazard of cancer recurrence in time to facilitate early detection of cancer recurrence. Materials and Methods The clinical data were extracted from the randomized Scandinavian Sarcoma Group (SSG) XVIII/Arbeitsgemeinschaft Internistische Onkologie (AIO) trial database. The SSG XVIII/AIO trial was registered (trial no. NCT00116935) and approved by the national or institutional review boards. In the trial, 1- and 3-year durations of adjuvant imatinib mesylate in the treatment of patients with gastrointestinal stromal tumor (GIST) were compared. A nonhomogeneous Poisson model with a piecewise log-constant hazard in time that accounts for the nonlinear pattern of GIST recurrence was applied to tumor site, mitotic count, and recurrence data. The optimal times to obtain follow-up CT scans were computed by modifying the frequency of CT scans with the hazard of tumor recurrence in time. The hazard-adjusted follow-up schedules were compared with the National Comprehensive Cancer Network (NCCN) guidelines of the United States, which suggest imaging with CT at intervals of 3-6 months for 3-5 years and then annually. Results Optimized timing of CT scans on the basis of hazard of recurrence resulted in follow-up schedule options where CT is performed more sparsely than in the NCCN guidelines during adjuvant imatinib administration and more frequently, at approximately 3-month intervals, during the first 2 years that follow imatinib discontinuation when the risk of recurrence was the greatest. The number of CT scans could be reduced by a median of 31% (from 13 to nine) compared with the standard schedules within the first 6 years of follow-up without increasing the delay in recurrence detection. Conclusion Detection of GIST recurrence may be enhanced by adjusting the timing of the CT scans with the hazard of recurrence. The method may be applicable to other human tumor types. © RSNA, 2013 Online supplemental material is available for this article.},
  author       = {Joensuu, Heikki and Reichardt, Peter and Eriksson, Mikael and Hall, Kirsten Sundby and Vehtari, Aki},
  issn         = {1527-1315},
  language     = {eng},
  number       = {1},
  pages        = {96--103},
  publisher    = {Radiological Society of North America},
  series       = {Radiology},
  title        = {Gastrointestinal Stromal Tumor: A Method for Optimizing the Timing of CT Scans in the Follow-up of Cancer Patients.},
  url          = {http://dx.doi.org/10.1148/radiol.13131040},
  volume       = {271},
  year         = {2014},
}