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- Title
The prognostic and predictive value of vascular response parameters measured by dynamic contrast-enhanced-CT, -MRI and -US in patients with metastatic renal cell carcinoma receiving sunitinib.
- Authors
Hudson, John M.; Bailey, Colleen; Atri, Mostafa; Stanisz, Greg; Milot, Laurent; Williams, Ross; Kiss, Alex; Burns, Peter N.; Bjarnason, Georg A.
- Abstract
<bold>Objectives: </bold>To identify dynamic contrast-enhanced (DCE) imaging parameters from MRI, CT and US that are prognostic and predictive in patients with metastatic renal cell cancer (mRCC) receiving sunitinib.<bold>Methods: </bold>Thirty-four patients were monitored by DCE imaging on day 0 and 14 of the first course of sunitinib treatment. Additional scans were performed with DCE-US only (day 7 or 28 and 2 weeks after the treatment break). Perfusion parameters that demonstrated a significant correlation (Spearman p < 0.05) with progression-free survival (PFS) and overall survival (OS) were investigated using Cox proportional hazard models/ratios (HR) and Kaplan-Meier survival analysis.<bold>Results: </bold>A higher baseline and day 14 value for Ktrans (DCE-MRI) and a lower pre-treatment vascular heterogeneity (DCE-US) were significantly associated with a longer PFS (HR, 0.62, 0.37 and 5.5, respectively). A larger per cent decrease in blood volume on day 14 (DCE-US) predicted a longer OS (HR, 1.45). We did not find significant correlations between any of the DCE-CT parameters and PFS/OS, unless a cut-off analysis was used.<bold>Conclusions: </bold>DCE-MRI, -CT and ultrasound produce complementary parameters that reflect the prognosis of patients receiving sunitinib for mRCC. Blood volume measured by DCE-US was the only parameter whose change during early anti-angiogenic therapy predicted for OS and PFS.<bold>Key Points: </bold>• DCE-CT, -MRI and ultrasound are complementary modalities for monitoring anti-angiogenic therapy. • The change in blood volume measured by DCE-US was predictive of OS/PFS. • Baseline vascular heterogeneity by DCE-US has the strongest prognostic value for PFS.
- Subjects
RENAL cell carcinoma; CANCER chemotherapy; COMPUTED tomography; MAGNETIC resonance imaging; CANCER treatment; DIAGNOSIS; ANTINEOPLASTIC agents; HETEROCYCLIC compounds; INDOLE compounds; BLOOD volume; CLINICAL trials; COMPARATIVE studies; DIAGNOSTIC imaging; DRUG monitoring; KIDNEY tumors; RESEARCH methodology; MEDICAL cooperation; PROGNOSIS; RESEARCH; ULTRASONIC imaging; EVALUATION research; PREDICTIVE tests; CONTRAST media; KAPLAN-Meier estimator; THERAPEUTICS
- Publication
European Radiology, 2018, Vol 28, Issue 6, p2281
- ISSN
0938-7994
- Publication type
journal article
- DOI
10.1007/s00330-017-5220-2