[Show abstract][Hide abstract] ABSTRACT: Objective
To compare oncologic outcomes for segmental versus main renal vein invasion (RVI) in patients with renal cell carcinoma.
Patients undergoing extirpative surgery for RCC at our institution from 2003-2013 were stratified into five groups: T2 (n=135), T3a with fat invasion (n=185), T3a with segmental RVI (n=87), T3a with main RVI (n=64), and T3b disease (n=40). Kaplan-Meier survival analysis and multivariable Cox regression were performed to determine the impact of segmental RVI on recurrence-free survival (RFS) and cancer-specific survival (CSS). Harrell's C index was used to compare the prognostic accuracy of current and proposed staging models.
At a median follow-up of 37 months, both RFS and CSS were significantly worse for patients with main RVI as compared to segmental RVI (p = 0.03, p = 0.009, respectively). On multivariable analysis, main RVI had an increased risk of recurrence (HR 2.3, 95% confidence interval [CI] 1.1-4.4, p = 0.03) and CSS (HR 3.5, 95%CI 1.3-9.9, p = 0.02) compared to segmental RVI. Sub-stratifying T3a disease by separating segmental and main RVI improved prognostic accuracy compared to the current staging system for CSS (c indices 0.66 vs 0.59) and RFS (0.70 vs 0.60).
Main RVI is independently associated with worse RFS and CSS than segmental RVI. These findings may have significance for patient counseling and future staging guidelines.
BJU International 10/2015; DOI:10.1111/bju.13349 · 3.53 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: We developed a new scaffold for radionuclide-based imaging and therapy of clear cell renal cell carcinoma (ccRCC) targeting carbonic anhydrase IX (CAIX). Compound XYIMSR-01, a DOTA-conjugated, bivalent, low-molecular-weight ligand, has two moieties that target two separate sites on CAIX, imparting high affinity. We synthesized [111In]XYIMSR-01 in 73.8-75.8% (n = 3) yield with specific radioactivities ranging from 118 - 1,021 GBq/μmol (3,200-27,600 Ci/mmol). Single photon emission computed tomography of [111In]XYIMSR-01 in immunocompromised mice bearing CAIX-expressing SK-RC-52 tumors revealed radiotracer uptake in tumor as early as 1 h post-injection. Biodistribution studies demonstrated 26% injected dose per gram of radioactivity within tumor at 1 h. Tumor-to-blood, muscle and kidney ratios were 178.1 ± 145.4, 68.4 ± 29.0 and 1.7 ± 1.2, respectively, at 24 h post-injection. Retention of radioactivity was exclusively observed in tumors by 48 h, the latest time point evaluated. The dual targeting strategy to engage CAIX enabled specific detection of ccRCC in this xenograft model, with pharmacokinetics surpassing those of previously described radionuclide-based probes against CAIX.
[Show abstract][Hide abstract] ABSTRACT: Renal cell carcinoma (RCC) is common with more than 60,000 new cases in the United States yearly. No curative therapies are available for metastatic RCC. Improved methods of imaging metastatic RCC would be of value in identifying sites of occult disease and potentially for judging response to therapy. A 58-year-old man with known metastatic clear cell RCC was imaged with both F-FDG and F-DCFPyL PET/CT. F-DCFPyL is a small molecule inhibitor of the prostate-specific membrane antigen (PSMA), a target known to be highly expressed on solid tumor neovasculature. Relative to F-FDG, F-DCFPyL identified more lesions and demonstrated higher tumor radiotracer uptake.
Clinical nuclear medicine 09/2015; DOI:10.1097/RLU.0000000000000995 · 3.93 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Patient summary:
We found that the imaging test (99m)Tc-sestamibi SPECT/CT can be used to accurately diagnose two types of benign kidney tumors. This test may be eventually used to help better evaluate patients diagnosed with a renal tumor.
European Urology 09/2015; DOI:10.1016/j.eururo.2015.08.056 · 12.48 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Molecular imaging with positron emission tomography (PET) provides a powerful means of identifying and characterizing cancerous processes, as well as providing a quantitative framework within which response to therapy can be ascertained. Unfortunately, the most commonly used PET radiotracer, (18)F-fluorodeoxyglucose (FDG), has not demonstrated a definitive role in determining response to therapy in metastatic renal cell carcinoma (RCC). As a result, new radiotracers able to reliably image RCC could be of tremendous value for this purpose.
Five patients with known metastatic RCC were imaged with the low-molecular weight radiotracer (18)F-DCFPyL, an inhibitor of the prostate-specific membrane antigen at 60 min post injection. (18)F-DCFPyL PET/CT and conventional images (either contrast-enhanced computed tomography or magnetic resonance imaging) were centrally reviewed for suspected sites of disease.
In all five patients imaged, sites of putative metastatic disease were readily identifiable by abnormal (18)F-DCFPyL uptake, with overall more lesions detected than on conventional imaging. These PET-detected sites included lymph nodes, pancreatic parenchymal lesions, lung parenchymal lesions, a brain parenchymal lesion, and other soft tissue sites. (18)F-DCFPyL uptake ranged from subtle to intense with maximum standardized uptake values (SUVmax) for the identified lesions of 1.6-19.3. Based upon this small patient series, limited pathology and imaging follow-up of these patients suggests a higher sensitivity for (18)F-DCFPyL compared to conventional imaging in the detection of metastatic RCC (94.7 versus 78.9 %).
PSMA expression in the tumor neovasculature of RCC has been previously established and is believed to provide the basis for the imaging findings presented here. PSMA-based PET/CT with radiotracers such as (18)F-DCFPyL may allow more accurate staging of patients with RCC and conceivably the ability to predict and follow therapy in patients treated with agents targeting the neovasculature.
Annals of Nuclear Medicine 08/2015; DOI:10.1007/s12149-015-1017-z · 1.68 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Treatment options for small renal masses include partial nephrectomy (PN), ablation and active surveillance. We sought to compare patients who met the criteria for percutaneous ablation but underwent robotic PN to the rest of our robotic PN cohort. This was done in order to detect any safety concerns and to define any risk factors that might contraindicate the use of robotic PN, an oncologically superior procedure, in patients who qualify for ablation.
Our departmental renal mass registry was queried for patients who underwent robotic PN but also met criteria for percutaneous ablation. These were compared to the rest of the robotic PN cohort. Demographics, perioperative characteristics and recurrence data were compared.
Overall, 321 robotic PNs were identified. Of these, 26 (8.1%) met ablation criteria. Among patient characteristics, age and BMI were similar in both groups. Among operative characteristics, estimated blood loss (EBL) and operative time were similar. Warm ischemia time was significantly less for patients who met ablation criteria (14 vs. 17 minutes, p = 0.002). Mean tumor size was smaller for patients who met ablation criteria (2.3 vs. 2.7 cm, p = 0.012). Among postoperative characteristics, complications were similar overall and when present, stratified by Clavien grade.
Robotic PN is a safe, effective treatment option for small renal masses, even in patients who meet ablation criteria. There were no recurrences in our cohort and the majority of complications were Clavien grade 1.
Central European Journal of Urology 08/2015; 68(2):132-6. DOI:10.5173/ceju.2015.528
[Show abstract][Hide abstract] ABSTRACT: Patients presenting with a clinically localized renal mass should ideally be managed with a risk-adapted approach that incorporates data regarding the metastatic potential of a given tumour. Unfortunately, currently available anatomical imaging techniques are unable to reliably distinguish between the various types of renal tumours, which include both benign and malignant histologies. Nuclear imaging offers a potential noninvasive means to characterize clinically localized renal tumours. A number of nuclear imaging tests are currently under investigation for this purpose and might one day be incorporated into patient care.
[Show abstract][Hide abstract] ABSTRACT: To ensure the early detection of recurrent disease, all patients should undergo routine surveillance following partial nephrectomy for renal cell carcinoma. In order to optimize resource allocation and avoid unnecessary radiation exposure, the frequency and duration of surveillance should be tailored to the individual patient's risk of cancer recurrence. The evidence for surveillance after partial nephrectomy is presented reviewing the current literature on prognostic models and proposed surveillance protocols based on the timing and patterns of renal cell carcinoma recurrence. In addition, we review recent guidelines on post partial nephrectomy surveillance as well as the literature on novel imaging techniques that may aid in early disease discovery.
Current Urology Reports 04/2015; 16(4):489. DOI:10.1007/s11934-015-0489-7 · 1.51 Impact Factor