Metastatic Renal Cell Carcinoma: Radiologic Findings and Assessment of Response to Targeted Antiangiogenic Therapy by Using Multidetector CT
Metastatic Renal Cell Carcinoma: Radiologic Findings and Assessment of Response to Targeted Antiangiogenic Therapy by Using Multidetector CT
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DOI：
10.1148/rg.336125110
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发表时间：
2013-10-01
期刊：
影响因子：
5.5
通讯作者：
Nicolau Molina, Carlos
中科院分区：
文献类型：
--
作者：
Pano Brufau, Blanca;Sebastia Cerqueda, Carmen;Nicolau Molina, Carlos
转移性肾细胞癌 (RCC) 治疗的最新进展，例如使用新型抗血管生成药物的新分子疗法，导致了评估肿瘤治疗反应最常用指南的修订：实体瘤反应评估标准 (RECIST 1.1)。传统上，转移性肾细胞癌对治疗的反应评估是基于靶病灶大小的变化。然而，较新的抗血管生成疗法的作用机制更多地是细胞抑制性而非细胞毒性，这导致疾病稳定而不是肿瘤消退。肿瘤反应的这种变化使得 RECIST 1.1（其标准完全基于肿瘤大小的系统）不足以区分早期肿瘤进展的患者与疾病无进展且生存期延长的患者。新的标准，如在对比增强多探测器计算机断层扫描 (CT) 中看到的衰减、形态和结构的变化，正在被纳入用于评估转移性肾细胞癌对抗血管生成治疗的反应的新分类中。新的分类可以更好地评估肿瘤对新疗法的反应，但它们也有一些局限性。作者对这些系统（Choi、改良 Choi 和形态、衰减、大小和结构 (MASS) 标准）进行了实际回顾，解释了可能影响这些分类的可行性和可重复性的差异和局限性。作者回顾了多排 CT 在转移性肾细胞癌检测中的应用以及这些病变的不同外观和位置。他们还概述了新的抗血管生成疗法及其作用机制，并简要介绍了功能成像技术。功能成像技术，尤其是动态增强 CT，似乎有望用于评估转移性肾细胞癌对治疗的反应。尽管如此，在功能成像用于常规临床实践之前还需要进一步的研究。 (c) 北美放射学会，2013 年
Recent advances in treatment of metastatic renal cell carcinoma (RCC), such as new molecular therapies that use novel antiangiogenic agents, have led to revision of the most frequently used guideline to evaluate tumor response to therapy: Response Evaluation Criteria in Solid Tumors (RECIST 1.1). Assessment of the response of metastatic RCC to therapy has traditionally been based on changes in target lesion size. However, the mechanism of action of newer antiangiogenic therapies is more cytostatic than cytotoxic, which leads to disease stabilization rather than to tumor regression. This change in tumor response makes RECIST 1.1-a system whose criteria are based exclusively on tumor size-inadequate to discriminate patients with early tumor progression from those with more progression-free disease and prolonged survival. New criteria such as changes in attenuation, morphology, and structure, as seen at contrast-enhanced multidetector computed tomography (CT), are being incorporated into new classifications used to assess response of metastatic RCC to antiangiogenic therapies. The new classifications provide better assessments of tumor response to the new therapies, but they have some limitations. The authors provide a practical review of these systems-the Choi, modified Choi, and Morphology, Attenuation, Size, and Structure (MASS) criteria-by explaining their differences and limitations that may influence the feasibility and reproducibility of these classifications. The authors review the use of multidetector CT in the detection of metastatic RCC and the different appearances and locations of these lesions. They also provide an overview of the new antiangiogenic therapies and their mechanisms of action and a brief introduction to functional imaging techniques. Functional imaging techniques, especially dynamic contrast-enhanced CT, seem promising for assessing response of metastatic RCC to treatment. Nonetheless, further studies are needed before functional imaging can be used in routine clinical practice. (c) RSNA, 2013