Division of Hematology and Oncology, Department of Medicine, Lineberger Comprehensive Cancer Center, Chapel Hill, NC 27599, USA.
Urology. 2010 May;75(5):1108-13.e1. doi: 10.1016/j.urology.2009.06.105. Epub 2009 Nov 20.
To characterize radiographic intratumoral contrast enhancement in the primary tumor of patients with renal cell carcinoma treated with either sorafenib or sunitinib, and to compare the relationship between primary tumor response and loss of enhancement. Use of the antiangiogenic multitargeted tyrosine kinase inhibitors sorafenib and sunitinib in renal cell carcinoma often results in stabilization of tumor size based on measurement of external tumor diameter; however, internal tumor changes in enhancement have been occasionally noted.
Thirty patients who received sunitinib or sorafenib therapy were evaluated for primary tumor response with contrast-enhanced computed tomography images before and after at least 1 cycle of treatment. Evaluation of intratumoral contrast enhancement was quantified using a workstation that allowed for three-dimensional renderings of the kidney and measurement of density in Hounsfield units (HU). The relationship between loss of intratumoral enhancement and other outcome variables was examined.
A loss of enhancement within the primary tumor, following therapy with tyrosine kinase inhibitors, was positively associated with primary tumor response (P = .0053). Additionally, the degree of post-treatment tumor enhancement was positively associated with tumor response to tyrosine kinase inhibition (P = .045).
Intratumoral changes in computed tomography enhancement after receptor tyrosine kinase inhibition correlate with primary tumor response, and may be a useful adjunct to the standard response evaluation criteria in solid tumors (RECIST criteria) in assessing response to therapy. Prospective studies evaluating antiangiogenic agents should explore intratumoral changes in contrast enhancement as part of response criteria, and examine the effect of intratumoral changes on survival-based outcomes.
描述接受索拉非尼或舒尼替尼治疗的肾细胞癌患者原发肿瘤的瘤内对比增强的影像学特征，并比较原发肿瘤反应与增强消退之间的关系。抗血管生成多靶点酪氨酸激酶抑制剂索拉非尼和舒尼替尼在肾细胞癌中的应用通常会导致肿瘤大小根据外部肿瘤直径的测量而稳定，但偶尔也会注意到内部肿瘤增强的变化。
对至少接受 1 个周期治疗前后的增强 CT 图像进行评估，共 30 例接受舒尼替尼或索拉非尼治疗的患者被评估为原发肿瘤反应。使用工作站对瘤内对比增强进行定量评估，该工作站允许对肾脏进行三维渲染，并以亨氏单位（HU）测量密度。检查了瘤内增强消退与其他结局变量之间的关系。
在接受酪氨酸激酶抑制剂治疗后，原发肿瘤内的增强消退与原发肿瘤反应呈正相关（P =.0053）。此外，治疗后肿瘤增强的程度与酪氨酸激酶抑制的肿瘤反应呈正相关（P =.045）。
受体酪氨酸激酶抑制后 CT 增强的瘤内变化与原发肿瘤反应相关，可能是实体瘤标准反应评估标准（RECIST 标准）评估治疗反应的有用补充。评估抗血管生成药物的前瞻性研究应将对比增强的瘤内变化作为反应标准的一部分进行评估，并研究瘤内变化对生存相关结局的影响。
