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Metastatic Renal Cell Carcinoma (mRCC)
PII S1095-0397(99)00100-4
Clinical Positron Imaging Vol. 2, No. 6, 340. 1999 Copyright 2000 Elsevier Science Inc. Printed in the USA. All rights reserved. 1095-0397/99 $–see front matter
ABSTRACT
Metastatic Renal Cell Carcinoma (mRCC): Is There A Role of F-18-FDG-PET? H. Bihl1, O. Lang1, J. Schleicher2, H.-G. Mergenthaler2, K. Willms3, F. Eisenberger3 Departments of 1Nuclear Medicine, 2Oncology, and 3Urology, Katharinenhospital, Stuttgart, Germany
Background: Therapeutic options are poor in metastatic renal cell carcinoma (mRCC). Thus, the possible toxicity of further (experimental) therapies is an important issue. In slowly growing mRCC, one would prefer a wait and see strategy, whereas in case of rapid growth, more aggressive therapy strategies may be justified. It has been demonstrated for several tumor entities that uptake of F-18-FDG is correlated with the degree of malignancy and aggressiveness of the tumor. If this were the case for mRCCs too, FDG-PET could be helpful for the choice of treatment strategy, even before the growth behavior of the tumor becomes clinically evident. Purpose: Evaluation of whole-body F-18-FDG-PET in mRCCs with respect to the biological behavior of the tumor. Methods: A total of 53 F-18-FDG-PET whole-body scans were performed in 43 patients with mRCC (female: 15, male: 28, mean age: 61 years). The patients were divided into 2 groups, according to clinical history of their disease: slowly growing (16 patients) and rapidly growing (27 patients). After injection of an average dose of 370 MBq F-18-FDG ⫾ 10%, whole-body FDG-PET scans (18 scans in the slowly growing group and 35 scans in the rapidly growing group) were performed with a Siemens/CTI ECAT EXACT 47 scanner. Results: In a patient per patient analysis, FDG-PET scans gave an overall sensitivity of 78%. If the 2 groups were analyzed separately, there were striking differences in the sensitivity of the slowly growing tumors being only 40%, in the rapidly growing tumors, however, reaching 97%. Conclusion: In mRCC, FDG-PET shows a high sensitivity (97%) for rapidly growing, i.e., aggressive mRCCs, whereas sensitivity is low for slowly growing mRCCs. This different behavior is in line with the well-known heterogeneity of the biological behavior of RCCs. On the basis of the present data, one might assume that FDGuptake is correlated with the malignancy and aggressivity of the RCC and therefore FDG-PET may facilitate the decision for treatment strategies in mRCCs. Moreover, it would be attractive to investigate, whether FDG-PET scan findings may provide a prognostic in vivo parameter for mRCC. (Clin Pos Imag 1999;2:340) 2000 Elsevier Science Inc. All rights reserved.
340
Clinical Positron Imaging Vol. 2, No. 6, 340. 1999 Copyright 2000 Elsevier Science Inc. Printed in the USA. All rights reserved. 1095-0397/99 $–see front matter
ABSTRACT
Metastatic Renal Cell Carcinoma (mRCC): Is There A Role of F-18-FDG-PET? H. Bihl1, O. Lang1, J. Schleicher2, H.-G. Mergenthaler2, K. Willms3, F. Eisenberger3 Departments of 1Nuclear Medicine, 2Oncology, and 3Urology, Katharinenhospital, Stuttgart, Germany
Background: Therapeutic options are poor in metastatic renal cell carcinoma (mRCC). Thus, the possible toxicity of further (experimental) therapies is an important issue. In slowly growing mRCC, one would prefer a wait and see strategy, whereas in case of rapid growth, more aggressive therapy strategies may be justified. It has been demonstrated for several tumor entities that uptake of F-18-FDG is correlated with the degree of malignancy and aggressiveness of the tumor. If this were the case for mRCCs too, FDG-PET could be helpful for the choice of treatment strategy, even before the growth behavior of the tumor becomes clinically evident. Purpose: Evaluation of whole-body F-18-FDG-PET in mRCCs with respect to the biological behavior of the tumor. Methods: A total of 53 F-18-FDG-PET whole-body scans were performed in 43 patients with mRCC (female: 15, male: 28, mean age: 61 years). The patients were divided into 2 groups, according to clinical history of their disease: slowly growing (16 patients) and rapidly growing (27 patients). After injection of an average dose of 370 MBq F-18-FDG ⫾ 10%, whole-body FDG-PET scans (18 scans in the slowly growing group and 35 scans in the rapidly growing group) were performed with a Siemens/CTI ECAT EXACT 47 scanner. Results: In a patient per patient analysis, FDG-PET scans gave an overall sensitivity of 78%. If the 2 groups were analyzed separately, there were striking differences in the sensitivity of the slowly growing tumors being only 40%, in the rapidly growing tumors, however, reaching 97%. Conclusion: In mRCC, FDG-PET shows a high sensitivity (97%) for rapidly growing, i.e., aggressive mRCCs, whereas sensitivity is low for slowly growing mRCCs. This different behavior is in line with the well-known heterogeneity of the biological behavior of RCCs. On the basis of the present data, one might assume that FDGuptake is correlated with the malignancy and aggressivity of the RCC and therefore FDG-PET may facilitate the decision for treatment strategies in mRCCs. Moreover, it would be attractive to investigate, whether FDG-PET scan findings may provide a prognostic in vivo parameter for mRCC. (Clin Pos Imag 1999;2:340) 2000 Elsevier Science Inc. All rights reserved.
340