Article

Immunotherapy response evaluation with (18)F-FDG-PET in patients with advanced stage renal cell carcinoma.

Department of Nuclear Medicine, Radboud University Nijmegen Medical Centre, PO Box 9101, 6500 HB, Nijmegen, The Netherlands, .
World Journal of Urology (Impact Factor: 2.89). 07/2011; DOI: 10.1007/s00345-011-0723-y
Source: PubMed

ABSTRACT BACKGROUND: CT imaging is widely used for response evaluation of immunotherapy in patients with advanced stage renal cell carcinoma (RCC). However, this kind of treatment may not immediately be cytoreductive, although the treatment is successful. This poses new demands on imaging modalities. Positron emission tomography (PET) using (18)F-fluorodeoxyglucose (FDG) proved to be useful in monitoring the effect of several antitumour treatments. We investigated the potential of FDG-PET for the evaluation of response to immunotherapy. METHODS: In seven patients with metastasized RCC, who were treated with either interferon-alpha (IFN-α) monotherapy or a combination of IFN-α, interleukin-2 and 5-fluorouracil, FDG-PET was performed prior and after 5 and 9 weeks of treatment. Quantitative changes of glucose metabolic rate (MR(Glu)) were compared with changes in tumour size on CT imaging using Response Evaluation Criteria in Solid Tumors (RECIST) and to survival and progression-free survival. RESULTS: No consistent changes in MR(Glu) were observed within different response groups. And no correlation with CT imaging, neither with survival or progression-free survival, was found. CONCLUSION: In contrast to the positive results reported on (chemo) therapy response evaluation with FDG-PET in different malignancies, this imaging modality appears not useful in response monitoring of immunotherapeutic modalities in RCC.

0 Bookmarks
 · 
91 Views
  • [Show abstract] [Hide abstract]
    ABSTRACT: The use of dynamic (18)F-FDG PET to determine changes in tumor metabolism requires tumor and plasma time-activity curves. Because arterial sampling is invasive and laborious, our aim was to validate noninvasive image-derived input functions (IDIFs). We obtained 136 dynamic (18)F-FDG PET scans of 76 oncologic patients. IDIFs were determined using volumes of interest over the left ventricle, ascending aorta, and abdominal aorta. The tumor metabolic rate of glucose (MRGlu) was determined with the Patlak analysis, using arterial plasma time-activity curves and IDIFs. MRGlu using all 3 IDIFs showed a high correlation with MRGlu based on arterial sampling. Comparability between the measures was also high, with the intraclass correlation coefficient being 0.98 (95% confidence interval, 0.97-0.99) for the ascending aorta IDIF, 0.94 (0.92-0.96) for the left ventricle IDIF, and 0.96 (0.93-0.98) for the abdominal aorta IDIF. The use of IDIFs is accurate and simple and represents a clinically viable alternative to arterial blood sampling.
    Journal of Nuclear Medicine 07/2006; 47(6):945-9. · 5.77 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: [F-18]-fluoro-2-deoxy-D-glucose positron emission tomography (FDG-PET) is a non-invasive imaging technique which has recently been validated for the assessment of therapy response in patients with aggressive non-Hodgkin's lymphoma. Our objective was to determine its value for the evaluation of immunotherapy efficacy in immunocompetent Balb/c mice injected with the A20 syngeneic B lymphoma cell line. The high level of in vitro FDG uptake by A20 cells validated the model for further imaging studies. When injected intravenously, the tumour developed as nodular lesions mostly in liver and spleen, thus mimicking the natural course of an aggressive human lymphoma. FDG-PET provided three-dimensional images of tumour extension including non-palpable lesions, in good correlation with ex vivo macroscopic examination. When mice were pre-immunized with an A20 cell lysate in adjuvant before tumour challenge, their significantly longer survival, compared to control mice, were associated with a lower incidence of lymphoma visualized by PET at different time points. Estimation of tumour growth and metabolism using the calculated tumour volumes and maximum standardized uptake values, respectively, also demonstrated delayed lymphoma development and lower activity in the vaccinated mice. Thus, FDG-PET is a sensitive tool relevant for early detection and follow-up of internal tumours, allowing discrimination between treated and non-treated small animal cohorts without invasive intervention.
    Cancer Immunology and Immunotherapy 09/2007; 56(8):1163-71. · 3.64 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: This report is a patterns-of-failure analysis of resected renal cell carcinoma (RCC) performed to determine the relative incidences of local failure (LF) and distant failure, to identify the pathologic features predicting for each using a multivariate analysis, and to assess the relative impact of each form of failure on overall survival (OS). In this way, the potential value of and selection of patients for adjuvant local and/or systemic therapy can be better evaluated. The records of 172 patients with unilateral, nonmetastatic RCC who were treated with definitive surgery between 1978 and 1988, and who had a minimum follow-up duration of 1 year, were identified through the Memorial Sloan-Kettering tumor registry. Distribution by stage included T1, 10 patients; T2, 102; T3a, 32; T3b, 27; and T4, one. The incidences of positive lymph nodes (LNs) and positive margins were 5.8% and 6.4%, respectively. LF developed in only six patients, yielding a 7-year actuarial incidence of 5%. In this subset, four patients developed distant metastases (DM), three occurring concurrently with or before LF. DM developed in 30 patients, yielding a 7-year actuarial incidence of 26%. Among the variables that had an impact on the development of DM according to univariate log-rank tests, only positive LNs (P = .026) and renal vein extension (P = .001) remained as significant independent prognosticators. The overall 7-year actuarial survival rate was 80%. Eleven patients died of RCC during follow-up, nine of whom (82%) died of metastatic disease. LF is rare following surgical management of RCC, and shows no clear causal relationship with the development of DM. Patients die of DM, and not LF. These data do not support the role of adjuvant radiation therapy in this disease. Patients with LN involvement or renal vein extension have a significantly increased risk for developing DM, and are therefore appropriate candidates for trials investigating systemic therapy.
    Journal of Clinical Oncology 02/1994; 12(1):206-12. · 18.04 Impact Factor

Full-text (2 Sources)

Download
29 Downloads
Available from
May 23, 2014