From the Department of Radiology (A.D.d.L., A.P., D.N.C., I.P.), Advanced Imaging Research Center (D.N.C., I.P.), Department of Pathology (P.K.), Department of Urology (P.K.), Kidney Cancer Program-Simmons Comprehensive Cancer Center (P.K., H.H., J.B., I.P.), and Department of Internal Medicine (H.H., J.B.), UT Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX 75390.
Radiographics. 2019 Jul-Aug;39(4):998-1016. doi: 10.1148/rg.2019180178. Epub 2019 Jun 14.
Locally advanced and metastatic renal cell carcinoma (RCC) present a specific set of challenges to the radiologist. The detection of metastatic disease is confounded by the ability of RCC to metastasize to virtually any part of the human body long after surgical resection of the primary tumor. This includes sites not commonly included in routine surveillance, which come to light after the patient becomes symptomatic. In the assessment of treatment response, the phenomenon of tumor heterogeneity, where clone selection through systemic therapy drives the growth of potentially more aggressive phenotypes, can result in oligoprogression despite overall disease control. Finally, advances in therapy have resulted in the development of immuno-oncologic agents that may result in changes that are not adequately evaluated with conventional size-based response criteria and may even be misinterpreted as progression. This article reviews the common challenges a radiologist may encounter in the evaluation of patients with locally advanced and metastatic RCC. RSNA, 2019.
局部晚期和转移性肾细胞癌 (RCC) 给放射科医生带来了一系列特殊的挑战。RCC 在原发性肿瘤切除后很长时间内几乎可以转移到人体的任何部位，这使得转移性疾病的检测变得复杂。这些部位通常不包括在常规监测中，只有在患者出现症状后才会被发现。在评估治疗反应时，肿瘤异质性的现象，即通过系统治疗进行克隆选择，导致潜在侵袭性更强的表型生长，尽管总体疾病得到控制，但仍可能导致寡进展。最后，治疗的进步导致了免疫肿瘤药物的发展，这些药物可能导致常规基于大小的反应标准无法充分评估的变化，甚至可能被误解为进展。本文回顾了放射科医生在评估局部晚期和转移性 RCC 患者时可能遇到的常见挑战。RSNA，2019 年。
