评估肿瘤治疗的反应对于确定预后和确定每位患者的最佳治疗至关重要。可以使用多种生物标志物，包括成像，但标准化是一致性和可靠性的基础。国际团体已定义肿瘤反应评估标准，用于评估新药或治疗策略的药物临床试验。 RECIST 1.1 标准完全基于一维病变测量；肿瘤大小的变化被用作替代成像生物标志物，与患者的治疗结果相关联。然而，肿瘤大小的增加并不总是反映肿瘤的进展。免疫疗法的引入导致了新标准（iRECIST，证据水平（LoE）Ib）的制定，该标准考虑了疾病负担的增加继发于免疫反应而不是进展的可能性，并提出了“未经证实的进展”的新概念。疾病（必须在随访中确认的首次进展事件）。针对 HCC 设计了具体标准（mRECIST、LoE IV），仅测量增强的 HCC 部分以解释局部治疗后的变化。对于用伊马替尼治疗的 GIST，通过评估 CT 上的肿瘤大小和密度，制定了标准来解释反映反应而非进展的大小可能增加（Choi，LoE II）。本文为普通放射科医生提供了简明且相关的实践建议，以帮助选择和应用最合适的标准来评估不同肿瘤情况下的治疗反应。尽管这些标准是为临床试验制定的，但它们可以作为日常解释的指南应用于临床实践。要点：专为临床试验而设计的疗效评估标准可以作为总体生存率的替代生物标志物。 RECIST 1.1定义了可测量和不可测量的疾病，其中在基线时选择目标病灶和非目标病灶作为随访的参考。某些疗法和/或癌症需要使用不同的标准，例如 iRECIST、mRECIST 和 Choi 标准。© 2024。作者。

Assessing the response to oncological treatments is paramount for determining the prognosis and defining the best treatment for each patient. Several biomarkers, including imaging, can be used, but standardization is fundamental for consistency and reliability. Tumor response evaluation criteria have been defined by international groups for application in pharmaceutical clinical trials evaluating new drugs or therapeutic strategies. RECIST 1.1 criteria are exclusively based on unidimensional lesion measurements; changes in tumor size are used as surrogate imaging biomarkers to correlate with patient outcomes. However, increased tumor size does not always reflect tumor progression. The introduction of immunotherapy has led to the development of new criteria (iRECIST, Level of Evidence (LoE) Ib) that consider the possibility that an increase in disease burden is secondary to the immune response instead of progression, with the new concept of Unconfirmed Progressive Disease (a first progression event which must be confirmed on follow-up). Specific criteria were devised for HCC (mRECIST, LoE IV), which measure only enhancing HCC portions to account for changes after local therapy. For GIST treated with imatinib, criteria were developed to account for the possible increase in size reflecting a response rather than a progression by assessing both tumor size and density on CT (Choi, LoE II). This article provides concise and relevant practice recommendations aimed at general radiologists to help choose and apply the most appropriate criteria for assessing response to treatment in different oncologic scenarios. Though these criteria were developed for clinical trials, they may be applied in clinical practice as a guide for day-to-day interpretation. KEY POINTS: Response evaluation criteria, designed for use in clinical trials, might serve as a surrogate biomarker for overall survival. RECIST 1.1 defines measurable and non-measurable disease among which target lesions and non-target lesions are selected at baseline as reference for follow-ups. Some therapies and/or cancers require the use of different criteria, such as iRECIST, mRECIST, and Choi criteria.© 2024. The Author(s).