Assessing Tumor Response and Detecting Recurrence in Metastatic Renal Cell Carcinoma on Targeted Therapy: Importance of Size and Attenuation on Contrast-Enhanced CT
- 1 January 2010
- journal article
- Published by American Roentgen Ray Society in American Journal of Roentgenology
- Vol. 194 (1), 157-165
- https://doi.org/10.2214/ajr.09.2941
Abstract
OBJECTIVE. The aim of this study was to improve response assessment in patients with metastatic renal cell carcinoma (RCC) on antiangiogenic targeted therapy by evaluating changes in both tumor size and attenuation and by detecting unique patterns of contrast enhancement on contrast-enhanced CT (CECT). MATERIALS AND METHODS. Tumor long-axis measurements and volumetric mean tumor attenuation of target lesions on CECT images were correlated with time to progression in 53 patients with metastatic clear cell RCC treated with first-line sorafenib or sunitinib. The frequencies of specific patterns of tumor progression were assessed. The data were used to develop new imaging criteria, the size and attenuation CT (SACT) criteria. CECT findings were evaluated using the SACT criteria, Response Evaluation Criteria in Solid Tumors (RECIST), and modified Choi criteria, and the Kaplan-Meier method was used to estimate survival functions. RESULTS. One or more target metastatic lesions had decreased attenuation of ≥ 40 HU in 59% of patients with progression-free survival of > 250 days (n = 44) after initiating targeted therapy; 0% of patients with earlier disease progression (n = 9) had this finding. A favorable response based on SACT criteria had a sensitivity of 75% and specificity of 100% for identifying patients with progression-free survival of > 250 days, versus 16% and 100%, respectively, for RECIST and 93% and 44% for the modified Choi criteria. CONCLUSION. Objectively measuring changes in both tumor size and attenuation on the first CECT study after initiating targeted therapy for metastatic RCC markedly improves response assessment. Distinct patterns of disease recurrence are seen in patients with metastatic RCC on targeted therapy.Keywords
This publication has 25 references indexed in Scilit:
- Response Evaluation of Gastrointestinal Stromal TumorsThe Oncologist, 2008
- Role of sunitinib and sorafenib in the treatment of metastatic renal cell carcinomaAmerican Journal of Health-System Pharmacy, 2008
- CT and PET: Early Prognostic Indicators of Response to Imatinib Mesylate in Patients with Gastrointestinal Stromal TumorAmerican Journal of Roentgenology, 2007
- Sunitinib Efficacy Against Advanced Renal Cell CarcinomaJournal of Urology, 2007
- Pathological evidence of necrosis in recurrent renal mass following treatment with sunitinibInternational Journal of Urology, 2007
- ASCO 2006 highlights: Targeted therapy for renal cell carcinomaCancer Treatment Reviews, 2007
- We Should Desist Using RECIST, at Least in GISTJournal of Clinical Oncology, 2007
- Sorafenib in Advanced Clear-Cell Renal-Cell CarcinomaThe New England Journal of Medicine, 2007
- Activity of SU11248, a Multitargeted Inhibitor of Vascular Endothelial Growth Factor Receptor and Platelet-Derived Growth Factor Receptor, in Patients With Metastatic Renal Cell CarcinomaJournal of Clinical Oncology, 2006
- New Guidelines to Evaluate the Response to Treatment in Solid TumorsJNCI Journal of the National Cancer Institute, 2000