When using CT scans for progression - 1265298

malki13
Posts:92

When using Ct scans to watch for progression .....what measurement indicates aggression or indolence or concern? I realize there is not a specific number and I'm not asking for that. Would it be accurate that any increase lets say 3.9-4.3 in three months is significant? Or is doubling time the criteria?. Any insight would be much appreciated.

Thank you
Malki

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Reply # - August 6, 2014, 12:10 PM

JimC
Posts: 2753

Hi Malki,

It's really a judgment call. For example, a smaller change that appears on each of a few successive scans is more concerning than that same change on just one scan. And a small change to a number of nodules might be considered evidence of progression that might warrant a treatment change. But the overall condition of the patient and control of other areas of cancer is also relevant. The example you give, 3.9 cm to 4.3 cm is probably not too concerning, because a good part of the difference of 4 mm from one scan to the next could be attributed to how the images "cut" and actually indicate a smaller change in size.

JimC
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Reply # - August 6, 2014, 01:28 PM

JimC
Posts: 2753

What I meant was that a 5mm increase in one 3 month interval may be less concerning if it's not repeated on the next scan than a 3 mm difference on each of three successive scans performed at three month intervals, which might indicate a consistent pattern of progression.

JimC
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Reply # - August 6, 2014, 08:30 PM

Dr West
Posts: 4735

As your discussion notes, there's no magic number. Part of the reason it depends is that a change of 3-4 mm over 3 months is far more concerning in an otherwise healthy 52 year-old than in an 84 year-old who walks with a walker and has significant heart disease. The cancer is far more likely to be threatening and clinically significant in younger, more fit patients.

Beyond that, what is considered concerning is going to vary even among specialists looking at the case and scans. While "beauty is in the eye of the holder", the same can be said for clinically significant progression.

Good luck.

-Dr. West

Reply # - August 6, 2014, 09:18 PM

malki13
Posts: 92

Thank you...so that seems consistent with the pulmonologist who said that the pathology would be much more threatening and concerning if it was me(although I'm younger than that) than for my mom...although I thought that was just because age changes the rate based on cellular growth not fitness.

My mom while having heart disease is pretty healthy for her age...in fact everyone except for her in her complex DO walk with walkers...not her..but Im hoping your example was not specific to walkers and just the obvious comparison. Well my moms big tumor was 4.7 x 5.0 in April and in June it was 5.5 x4.6 I did read somewhere that 20% is a standard for progression but Ill be sure to ask the doctor his thoughts on my moms rate for her.

thank you again
Malki

Reply # - August 7, 2014, 11:04 AM

Dr West
Posts: 4735

20% is a standard for progression on an investigational treatment in a trial, not really applicable to every setting. It's a judgment call tailored to the patient.

-Dr. West

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