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

• Published in: European radiology 2018-06, Vol.28 (6), p.2281-2290
• Main Authors: Hudson, John M., Bailey, Colleen, Atri, Mostafa, Stanisz, Greg, Milot, Laurent, Williams, Ross, Kiss, Alex, Burns, Peter N., Bjarnason, Georg A.
• Format: Article
• Language: English
• Subjects: Adult; Aged; Aged, 80 and over; Angiogenesis; Antineoplastic Agents - therapeutic use; Blood; Blood Volume; Carcinoma, Renal Cell - diagnostic imaging; Carcinoma, Renal Cell - drug therapy; Carcinoma, Renal Cell - secondary; Computed tomography; Contrast Media; Diagnostic Radiology; Disease-Free Survival; Drug Monitoring - methods; Female; Heterogeneity; Humans; Imaging; Indoles - therapeutic use; Inhibitor drugs; Internal Medicine; Interventional Radiology; Kaplan-Meier Estimate; Kidney cancer; Kidney Neoplasms - diagnostic imaging; Kidney Neoplasms - drug therapy; Magnetic resonance imaging; Magnetic Resonance Imaging - methods; Male; Medical prognosis; Medicine; Medicine & Public Health; Metastases; Metastasis; Middle Aged; Multimodal Imaging - methods; Neuroradiology; Oncology; Parameter identification; Patients; Perfusion; Predictive Value of Tests; Prognosis; Pyrroles - therapeutic use; Radiology; Renal cell carcinoma; Statistical models; Sunitinib; Survival; Survival analysis; Targeted cancer therapy; Therapy; Tomography, X-Ray Computed - methods; Ultrasonic imaging; Ultrasonography - methods; Ultrasound
• ISSN: 0938-7994; 1432-1084
• DOI: 10.1007/s00330-017-5220-2

Objectives 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. Methods 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. Results 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. Conclusions 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. Key Points • 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.