Table 1.

The UICC, WHO, and MDA Criteria for Detection of Bone Response

Response Type	UICCa	WHOb	Revised Criteria for Assessment of Bone Response (MDA)
Target Diagnostic Imaging	XR	XR, SS	XR, SS, CT, MRI
Complete Response	Disappearance of all known disease Lytic lesions should have radiologic evidence of calcification	Complete disappearance of all lesions on XR or scan for at least 4 wk	Complete fill-in or sclerosis of lytic lesion on XR and CT Disappearance of hot spots or tumor signal on SS, CT, or MRI Normalization of osteoblastic lesion on XR and CT
Partial Response	At least 50% decrease in size of measurable lesions Objective improvement in evaluable or unmeasurable lesions No new lesions or progressive lesions	Partial decrease in size of lytic lesions, recalcification of lytic lesions, or decreased density of blastic lesions for at least 4 wk	Sclerotic rim around initially lytic lesion or sclerosis of lesions previously undetected on XR or CT Partial fill-in or sclerosis of lytic lesion on XR or CT Regression of measurable lesion on XR, CT, or MRI Regression of lesion on SS (exclude rapid regressionc Decrease in blastic lesion on XR or CT
No Change or Stable Disease	Unchanged or between 25% increase and 50% decrease in size of measurable lesionsd	As a result of the slow response of bone lesions, the classification of “no change” should not be applied until at least 8 wk have passed from start of therapy	No change in measurable lesion on XR, CT, or MRI No change in blastic lesion on XR, CT, or MRI No new lesion on XR, SS, CT, or MRI
Progressive Disease	Mixed; some lesions persist while others progress or new lesions appear Failure; some or all lesions progress and/or new lesions appear; no lesions regress	Increase in size of existing lesions or appearance of new lesions	Increase in size of any existing measurable lesions on XR, CT, or MRI New lesion on XR, SS (excluding flare phenomena), CT, or MRI Increase in activity on SS (excluding flare phenomena) or blastic/lytic lesion on XR or CT

Abbreviations: CT = computed tomography; MDA = MD Anderson; MRI = magnetic resonance imaging; SS = skeletal scintigraphy; XR = plain radiography; UICC = Union Against Cancer; WHO = World Health Organization.

^aCriteria are based on plain radiography; the duration of response is to be measured from the start of therapy until either new lesions appear or any 1 existing lesion increases by 25% or more beyond its smallest recorded size.

^bOccurrence of bone compression or fracture and its healing should not be used as the sole indicator for evaluation of therapy.

^cRapid osteolytic progression may show decreased osteoblastic activity, resulting in regression of “hot spots” on SS. XR or CT may be helpful in detecting progressive osteolysis and thus help identify progressive disease (PD) in this situation.

^dIf lesions that cannot be measured but are otherwise evaluable represent the bulk of disease and these lesions clearly do not respond even though measurable lesions have improved, the response is considered to be “no change” rather than an “objective regression.”

Reproduced with permission from Hamaoka T, et al. Tumour response interpretation with new tumour response criteria vs the World Health Organisation criteria in patients with bone-only metastatic breast cancer. Br J Cancer 2010; 102:651-7.