van Oostenbrugge Tim J, Langenhuijsen Johan F, Oosterwijk Egbert, Boerman Otto C, Jenniskens Sjoerd F, Oyen Wim J G, Fütterer Jurgen J, Mulders Peter F A
Department of Urology, Radboud University Medical Center, 6500, HB, Nijmegen, the Netherlands.
Department of Radiology and Nuclear Medicine, Radboud University Medical Center, Nijmegen, the Netherlands.
Eur J Nucl Med Mol Imaging. 2020 Jul;47(8):1864-1870. doi: 10.1007/s00259-019-04613-z. Epub 2019 Nov 25.
Detection of residual or recurrent vital renal tumor on follow-up (FU) cross-sectional imaging after ablative therapy is challenging. The specific and high expression levels of carbonic anhydrase IX (CAIX) in clear cell renal cell carcinoma (ccRCC) makes it a suitable target for imaging using radiolabeled anti-CAIX antibody girentuximab. The objective of this study was to evaluate the feasibility of targeted FU imaging 1 month after cryoablation of ccRCC using single photon emission computed tomography (SPECT) after In-labeled girentuximab administration.
In this prospective study 16 patients underwent In-girentuximab-SPECT before MR-guided renal cryoablation between February 2015 and September 2018. In case of tumor targeting In-girentuximab-SPECT was repeated 1 month following MR-guided cryoablation. Presence of residual or recurrent vital tumor was assessed on contrast-enhanced cross-sectional imaging during further FU. The standard FU imaging protocol consisted of MRI/CT scans at 1, 3, 6, 12, and 18 months and annually thereafter.
A total of 10 (63%) patients showed positive tumor targeting on In-girentuximab-SPECT before cryoablation and 9 ( 56%) were eligible to undergo FU SPECT. Of the 9 In-girentuximab-SPECT FU scans, 8 (89%) were considered negative. One (11%) scan showed uptake suggestive for residual vital tumor. Six months after treatment, FU CT showed contrast enhancement suggestive for residual/recurrent disease in the ablated zone at the site of the In-girentuximab uptake after treatment. During a mean FU of 21 months (range 1-33) no other cases with residual/recurrent disease were detected.
FU imaging with In-girentuximab-SPECT is feasible after ccRCC cryoablation and may contribute to early detection of residual or recurrent disease.
在消融治疗后的随访（FU）横断面成像中检测残留或复发性有活力的肾肿瘤具有挑战性。碳酸酐酶IX（CAIX）在透明细胞肾细胞癌（ccRCC）中具有特异性且高表达水平，这使其成为使用放射性标记的抗CAIX抗体吉瑞替尼单抗进行成像的合适靶点。本研究的目的是评估在给予铟标记的吉瑞替尼单抗后，使用单光子发射计算机断层扫描（SPECT）对ccRCC进行冷冻消融1个月后进行靶向FU成像的可行性。
在这项前瞻性研究中，2015年2月至2018年9月期间，16例患者在磁共振引导下肾冷冻消融术前接受了铟标记的吉瑞替尼单抗-SPECT检查。如果肿瘤有靶向性，则在磁共振引导下冷冻消融术后1个月重复进行铟标记的吉瑞替尼单抗-SPECT检查。在进一步的随访期间，通过增强横断面成像评估残留或复发性有活力肿瘤的存在情况。标准的FU成像方案包括在1、3、6、12和18个月时进行MRI/CT扫描，此后每年进行一次。
共有10例（63%）患者在冷冻消融术前的铟标记的吉瑞替尼单抗-SPECT检查中显示肿瘤靶向阳性，9例（56%）患者符合进行FU SPECT检查的条件。在9次铟标记的吉瑞替尼单抗-SPECT FU扫描中，8次（89%）被认为是阴性。1次（11%）扫描显示摄取提示有残留的有活力肿瘤。治疗6个月后，FU CT显示在治疗后铟标记的吉瑞替尼单抗摄取部位的消融区有对比增强，提示有残留/复发性疾病。在平均21个月（范围1 - 33个月）的随访期间，未检测到其他残留/复发性疾病病例。
ccRCC冷冻消融术后使用铟标记的吉瑞替尼单抗-SPECT进行FU成像可行，可能有助于早期检测残留或复发性疾病。
