Role of positron emission tomography/computed tomography in the evaluation of renal cell carcinoma

Jena, Rahul; Narain, Tushar Aditya; Singh, Uday Pratap; Srivastava, Aneesh

doi:10.4103/iju.iju_268_20

Cited by 11 publications

(1 citation statement)

References 65 publications

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“…Fluorodeoxyglucose (FDG) Positron Emission Tomography (PET) is not currently regarded to be the standard imaging modality for the diagnosis of renal cancer [ 15 ], given its low sensitivity. As FDG is excreted by the kidneys, FDG PET is not suitable for local staging of primary RCC, but can be useful in metastatic RCC and to evaluate response to therapy.…”

Section: Diagnosismentioning

confidence: 99%

SEOM SOGUG clinical guideline for treatment of kidney cancer (2022)

Méndez-Vidal,

Lázaro Quintela,

Lainez-Milagro

et al. 2023

Clin Transl Oncol

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Renal cancer is the seventh most common cancer in men and the tenth in women. The aim of this article is to review the diagnosis, treatment, and follow-up of renal carcinoma accompanied by recommendations with new evidence and treatment algorithms. A new pathologic classification of RCC by the World Health Organization (WHO) was published in 2022 and this classification would be considered a “bridge” to a future molecular classification. For patients with localized disease, surgery is the treatment of choice with nephron-sparing surgery recommended when feasible. Adjuvant treatment with pembrolizumab is an option for intermediate-or high-risk cases, as well as patients after complete resection of metastatic disease. More data are needed in the future, including positive overall survival data. Clinical prognostic classification, preferably IMDC, should be used for treatment decision making in mRCC. Cytoreductive nephrectomy should not be deemed mandatory in individuals with intermediate-poor IMDC/MSKCC risk who require systemic therapy. Metastasectomy can be contemplated in selected subjects with a limited number of metastases or long metachronous disease-free interval. For the population of patients with metastatic ccRCC as a whole, the combination of pembrolizumab–axitinib, nivolumab–cabozantinib, or pembrolizumab–lenvatinib can be considered as the first option based on the benefit obtained in OS versus sunitinib. In cases that have an intermediate IMDC and poor prognosis, the combination of ipilimumab and nivolumab has demonstrated superior OS compared to sunitinib. As for individuals with advanced RCC previously treated with one or two antiangiogenic tyrosine-kinase inhibitors, nivolumab and cabozantinib are the options of choice. When there is progression following initial immunotherapy-based treatment, we recommend treatment with an antiangiogenic tyrosine-kinase inhibitor. While no clear sequence can be advocated, medical oncologists and patients should be aware of the recent advances and new strategies that improve survival and quality of life in the setting of metastatic RC.

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Section: Diagnosismentioning

confidence: 99%

SEOM SOGUG clinical guideline for treatment of kidney cancer (2022)

Méndez-Vidal,

Lázaro Quintela,

Lainez-Milagro

et al. 2023

Clin Transl Oncol

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18F‐fluoro‐2‐deoxy‐2‐d‐glucose PET‐CT (FDG PET‐CT) in staging of high‐risk renal and urothelial bladder cancers (COPPER‐T) trial protocol

et al. 2023

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Background and Study DesignRole of 18F‐fluoro‐2‐deoxy‐2‐d‐glucose positron emission tomography‐computed tomography (FDG PET‐CT) in evaluation of renal cell cancers (RCC) and urinary bladder cancers is not standardized, and the COPPER‐T trial, which is a single centre prospective randomized study, was designed to compare it with conventional imaging for staging of clinically localized high risk RCC and urinary bladder carcinoma (Stage T2 and above).Patients and MethodsThere will be two subgroups of patients: RCC and urinary bladder carcinoma. In each of these, the patients will be randomized to either Arm A or Arm B. In each of the arms, each patient will be subjected to diagnostic imaging by FDG PET‐CT. The CT scan will be a contrast‐enhanced scan like that in conventional staging. A radiologist and nuclear medicine specialist will report the scan independently. The radiologist will not have access to the PET scan sequences and will only review the contrast‐enhanced computed tomography (CECT) images. In Arm A, the report of the conventional imaging modality, that is, CECT and bone scan if done, will be reviewed first by the clinician, and based on this report, a management plan will be made. Then, the PET‐CT report will be reviewed, and change in the management plan will be noted. New findings or equivocal findings if any in the PET‐CT report would be noted. In Arm B, the report of the PET‐CT report will be reviewed first by the clinicians, and a management plan will be made. Then, the CECT and/or bone scan reports will be reviewed, and any change in the management plan will be noted.Outcome and SignificanceFinal analysis of the data after completion of the trial will help in clarifying the role of FDG PET‐CT in high risk RCC and transitional cell carcinoma (TCC) of the bladder, its diagnostic accuracy compared with conventional imaging and the impact of using it on patient management.

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PET/MR Imaging of a Lung Metastasis Model of Clear Cell Renal Cell Carcinoma with (2S,4R)-4-[18F]Fluoroglutamine

et al. 2022

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Purpose Metabolic reprogramming plays an important role in the tumorigenesis of clear cell renal cell carcinoma (ccRCC). Currently, positron emission tomography (PET) reporters are not used clinically to visualize altered glutamine metabolism in ccRCC, which greatly hinders detection, staging, and real-time therapeutic assessment. We sought to determine if (2S,4R)-4-[18F]fluoroglutamine ([18F]FGln) could be used to interrogate altered glutamine metabolism in ccRCC lesions in the lung. Procedures We generated a novel ccRCC lung lesion model using the ccRCC cell line UMRC3 stably transfected with GFP and luciferase constructs. This cell line was used for characterization of [18F]FGln uptake and retention by transport analysis in cell culture and by PET/MRI (magnetic resonance imaging) in animal models. Tumor growth in animal models was monitored using bioluminescence (BLI) and MRI. After necropsy, UMRC3 tumor growth in lung tissue was verified by fluorescence imaging and histology. Results In UMRC3 cells, [18F]FGln cell uptake was twofold higher than cell uptake in normal kidney HEK293 cells. Tracer cell uptake was reduced by 60–90% in the presence of excess glutamine in the media and by 20–50% upon treatment with V-9302, an inhibitor of the major glutamine transporter alanine-serine-cysteine transporter 2 (ASCT2). Furthermore, in UMRC3 cells, [18F]FGln cell uptake was reduced by siRNA knockdown of ASCT2 to levels obtained by the addition of excess exogenous glutamine. Conversely, [18F]FGln cellular uptake was increased in the presence of the glutaminase inhibitor CB-839. Using simultaneous PET/MRI for visualization, retention of [18F]FGln in vivo in ccRCC lung tumors was 1.5-fold greater than normal lung tissue and twofold greater than muscle. In ccRCC lung tumors, [18F]FGln retention did not change significantly upon treatment with CB-839. Conclusions We report one of the first direct orthotopic mouse models of ccRCC lung lesions. Using PET/MR imaging, lung tumors were easily discerned from normal tissue. Higher uptake of [18F]FGln was observed in a ccRCC cell line and lung lesions compared to HEK293 cells and normal lung tissue, respectively. [18F]FGln cell uptake was modulated by exogenous glutamine, V-9302, siRNA knockdown of ASCT2, and CB-839. Interestingly, in a pilot therapeutic study with CB-839, we observed no difference in treated tumors relative to untreated controls. This was in contrast with cellular studies, where CB-839 increased glutamine uptake.

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Role of positron emission tomography/computed tomography in the evaluation of renal cell carcinoma

Cited by 11 publications

References 65 publications

SEOM SOGUG clinical guideline for treatment of kidney cancer (2022)

SEOM SOGUG clinical guideline for treatment of kidney cancer (2022)

18F‐fluoro‐2‐deoxy‐2‐d‐glucose PET‐CT (FDG PET‐CT) in staging of high‐risk renal and urothelial bladder cancers (COPPER‐T) trial protocol

PET/MR Imaging of a Lung Metastasis Model of Clear Cell Renal Cell Carcinoma with (2S,4R)-4-[18F]Fluoroglutamine

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