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European Radiology

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05.05.2022 | Oncology

Early reduction in spectral dual-layer detector CT parameters as favorable imaging biomarkers in patients with metastatic renal cell carcinoma

verfasst von: Aska Drljevic-Nielsen, Jill R. Mains, Kennet Thorup, Michael Brun Andersen, Finn Rasmussen, Frede Donskov

Erschienen in: European Radiology | Ausgabe 11/2022

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Abstract

Objectives

To associate the early change in DL-CT parameters and HU with survival outcomes and treatment response in patients with metastatic renal cell carcinoma (mRCC).

Methods

DL-CT scans were performed at baseline and after 1 month of checkpoint immunotherapy or tyrosine kinase inhibitor therapy. Scans were reconstructed to conventional CT and DL-CT series, and used for assessment of HU, iodine concentration (IC), and the effective atomic number (Z_effective) in the combined RECISTv.1.1 target lesions. The relative changes, defined as ΔIC(combined), ΔZ_effective(combined), and ΔHU(combined), were associated with progression-free survival (PFS), overall survival (OS), and objective response rate (ORR). The reduction in the sum of diameters of target lesions ≥ 30% after 1 month was associated with OS, PFS, and ORR.

Results

Overall, 115 and 104 mRCC patients were included at baseline and 1 month, respectively. Median IC(combined) decreased from 2.3 to 1.2 mg/ml (p < 0.001), Z_effective(combined) from 8.5 to 8.0 (p < 0.001), and HU(combined) from 86.0 to 64.00 HU (p < 0.001). After multivariate adjustments, the largest reductions in ΔIC(combined) (HR 0.47, 95% CI: 0.24–0.94, p = 0.033) and ΔZ_effective(combined) (HR = 0.43, 95% CI: 0.21–0.87, p = 0.019) were associated with favorable OS; the largest reduction in ΔZ_effective(combined) was associated with higher response (OR = 2.79, 95% CI: 1.12–6.94, p = 0.027). The largest reduction in ΔHU(combined) was solely associated with OS in univariate analysis (HR 0.45, 95% CI: 0.23–0.91). Reduction in SOD ≥ 30% at 1 month was not associated with outcomes (p > 0.075).

Conclusions

Early reductions at 1 month in ΔIC(combined) and ΔZ_effective(combined) are associated with favorable outcomes in patients with mRCC. This information may reassure physicians and patients about treatment strategy.

Key Points

• Early reductions following 1 month of therapy in spectral dual-layer detector CT-derived iodine concentration and the effective atomic number (Z _effective ) are independent biomarkers for better overall survival in patients with metastatic renal cell carcinoma.

• Early reduction after 1 month of therapy in the effective atomic number (Z _effective ) is an independent imaging biomarker for better treatment response metastatic renal cell carcinoma.

Hsieh JJ, Purdue MP, Signoretti S et al (2017) Renal cell carcinoma. Nat Rev Dis Primers 3:17009. https://doi.org/10.1038/nrdp.2017.9CrossRef

Moch H, Cubilla AL, Humphrey PA, Reuter VE, Ulbright TM (2016) The 2016 WHO classification of tumours of the urinary system and male genital organs-part A: renal, penile, and testicular tumours. Eur Urol 70:93–105. https://doi.org/10.1016/j.eururo.2016.02.029CrossRef

Cancer Genome Atlas Research Network (2013) Comprehensive molecular characterization of clear cell renal cell carcinoma. Nature. 499:43–49. https://doi.org/10.1038/nature12222CrossRef

Siegel RL, Miller KD, Fuchs HE, Jemal A (2021) Cancer statistics, 2021. CA Cancer J Clin 71:7–33. https://doi.org/10.3322/caac.21654CrossRef

Dabestani S, Thorstenson A, Lindblad P, Harmenberg U, Ljungberg B, Lundstam S (2016) Renal cell carcinoma recurrences and metastases in primary non-metastatic patients: a population-based study. World J Urol 34:1081–1086. https://doi.org/10.1007/s00345-016-1773-yCrossRef

Eggener SE, Yossepowitch O, Pettus JA, Snyder ME, Motzer RJ, Russo P (2006) Renal cell carcinoma recurrence after nephrectomy for localized disease: predicting survival from time of recurrence. J Clin Oncol 24:3101–3106. https://doi.org/10.1200/JCO.2005.04.8280CrossRef

Gerwing M, Herrmann K, Helfen A et al (2019) The beginning of the end for conventional RECIST - novel therapies require novel imaging approaches. Nat Rev Clin Oncol 16:442–458. https://doi.org/10.1038/s41571-019-0169-5CrossRef

Motzer RJ, Penkov K, Haanen J et al (2019) Avelumab plus axitinib versus sunitinib for advanced renal-cell carcinoma. N Engl J Med 380:1103–1115. https://doi.org/10.1056/NEJMoa1816047CrossRef

Powles T, Plimack ER, Soulières D et al (2020) Pembrolizumab plus axitinib versus sunitinib monotherapy as first-line treatment of advanced renal cell carcinoma (KEYNOTE-426): extended follow-up from a randomised, open-label, phase 3 trial. Lancet Oncol 21:1563–1573. https://doi.org/10.1016/S1470-2045(20)30436-8CrossRef

10.

Choueiri TK, Escudier B, Powles T et al (2016) Cabozantinib versus everolimus in advanced renal cell carcinoma (METEOR): final results from a randomised, open-label, phase 3 trial. Lancet Oncol 17:917–927. https://doi.org/10.1016/S1470-2045(16)30107-3CrossRef

11.

Albiges L, Tannir NM, Burotto M et al (2020) Nivolumab plus ipilimumab versus sunitinib for first-line treatment of advanced renal cell carcinoma: extended 4-year follow-up of the phase III CheckMate 214 trial. ESMO Open 5:e001079. https://doi.org/10.1136/esmoopen-2020-001079CrossRef

12.

Choueiri TK, Powles T, Burotto M et al (2021) Nivolumab plus cabozantinib versus sunitinib for advanced renal-cell carcinoma. N Engl J Med 384:829–841. https://doi.org/10.1056/NEJMoa2026982CrossRef

13.

Motzer R, Alekseev B, Rha SY et al (2021) Lenvatinib plus pembrolizumab or everolimus for advanced renal cell carcinoma. N Engl J Med 384:1289–1300. https://doi.org/10.1056/NEJMoa2035716CrossRef

14.

Motzer RJ, Escudier B, George S et al (2020) Nivolumab versus everolimus in patients with advanced renal cell carcinoma: updated results with long-term follow-up of the randomized, open-label, phase 3 CheckMate 025 trial. Cancer. 126:4156–4416. https://doi.org/10.1002/cncr.33033CrossRef

15.

McDermott DF, Lee JL, Bjarnason GA et al (2021) Open-label, single-arm phase II study of pembrolizumab monotherapy as first-line therapy in patients with advanced clear cell renal cell carcinoma. J Clin Oncol 39:1029–1039. https://doi.org/10.1200/JCO.20.02363CrossRef

16.

McDermott DF, Lee JL, Ziobro M (2021) Open-label, single-arm, phase ii study of pembrolizumab monotherapy as first-line therapy in patients with advanced non-clear cell renal cell carcinoma. J Clin Oncol 39:1029–1039. https://doi.org/10.1200/jco.20.02365CrossRef

17.

Heng DY, MacKenzie MJ, Vaishampayan UN et al (2012) Primary anti-vascular endothelial growth factor (VEGF)-refractory metastatic renal cell carcinoma: clinical characteristics, risk factors, and subsequent therapy. Ann Oncol 23:1549–1555. https://doi.org/10.1093/annonc/mdr533CrossRef

18.

Eisenhauer EA, Therasse P, Bogaerts J et al (2009) New response evaluation criteria in solid tumours: revised RECIST guideline (version 1.1). Eur J Cancer 45:228–247. https://doi.org/10.1016/j.ejca.2008.10.026CrossRef

19.

Schwartz LH, Litiere S, de Vries E et al (2016) RECIST 1.1-update and clarification: from the RECIST committee. Eur J Cancer 62:132–137. https://doi.org/10.1016/j.ejca.2016.03.081CrossRef

20.

Simons D, Kachelriess M, Schlemmer HP (2014) Recent developments of dual-energy CT in oncology. Eur Radiol 24:930–939. https://doi.org/10.1007/s00330-013-3087-4CrossRef

21.

Andersen MB, Ebbesen D, Thygesen J, Kruis M, Rasmussen F (2020) Impact of spectral body imaging in patients suspected for occult cancer: a prospective study of 503 patients. Eur Radiol 30:5539–5550. https://doi.org/10.1007/s00330-020-06878-7CrossRef

22.

McCollough CH, Leng S, Yu L, Fletcher JG (2015) Dual- and multi-energy CT: principles, technical approaches, and clinical applications. Radiology. 276:637–653. https://doi.org/10.1148/radiol.2015142631CrossRef

23.

McCollough CH (2020) Methods for spectral CT imaging. In: Samei E, Pelc N (eds) Computed tomography. Springer, Cham, pp 223–242. https://doi.org/10.1007/978-3-030-26957-9_12CrossRef

24.

McCollough CH, Boedeker K, Cody D (2020) Principles and applications of multienergy CT: report of AAPM Task Group 291. Med Phys 47:e881–e912. https://doi.org/10.1002/mp.14157CrossRef

25.

Rassouli N, Etesami M, Dhanantwari A, Rajiah P (2017) Detector-based spectral CT with a novel dual-layer technology: principles and applications. Insights Imaging 8:589–598. https://doi.org/10.1007/s13244-017-0571-4CrossRef

26.

Sodickson AD, Keraliya A, Czakowski B, Primak A, Wortman J, Uyeda JW (2021) Dual energy CT in clinical routine: how it works and how it adds value. Emerg Radiol 28:103–117. https://doi.org/10.1007/s10140-020-01785-2CrossRef

27.

Thaiss WM, Haberland U, Kaufmann S et al (2016) Iodine concentration as a perfusion surrogate marker in oncology: further elucidation of the underlying mechanisms using volume perfusion CT with 80 kVp. Eur Radiol 26:2929–2936. https://doi.org/10.1007/s00330-015-4154-9CrossRef

28.

Mileto A, Marin D, Alfaro-Cordoba M et al (2014) Iodine quantification to distinguish clear cell from papillary renal cell carcinoma at dual-energy multidetector CT: a multireader diagnostic performance study. Radiology. 273:813–820. https://doi.org/10.1148/radiol.14140171CrossRef

29.

Marcon J, Graser A, Horst D et al (2020) Papillary vs clear cell renal cell carcinoma. Differentiation and grading by iodine concentration using DECT-correlation with microvascular density. Eur Radiol 30:1–10. https://doi.org/10.1007/s00330-019-06298-2CrossRef

30.

Udare A, Walker D, Krishna S et al (2020) Characterization of clear cell renal cell carcinoma and other renal tumors: evaluation of dual-energy CT using material-specific iodine and fat imaging. Eur Radiol 30:2091–2102. https://doi.org/10.1007/s00330-019-06590-1CrossRef

31.

Drljevic-Nielsen A, Donskov F, Mains JR et al (2021) Prognostic utility of parameters derived from pretreatment dual-layer spectral-detector ct in patients with metastatic renal cell carcinoma. AJR Am J Roentgenol 218:1–11. https://doi.org/10.2214/ajr.21.26911CrossRef

32.

Hellbach K, Sterzik A, Sommer W et al (2017) Dual energy CT allows for improved characterization of response to antiangiogenic treatment in patients with metastatic renal cell cancer. Eur Radiol 27:2532–2537. https://doi.org/10.1007/s00330-016-4597-7CrossRef

33.

Heng DY, Xie W, Regan MM et al (2009) Prognostic factors for overall survival in patients with metastatic renal cell carcinoma treated with vascular endothelial growth factor-targeted agents: results from a large, multicenter study. J Clin Oncol 27:5794–5799. https://doi.org/10.1200/JCO.2008.21.4809CrossRef

34.

Turajlic S, Xu H, Litchfield K et al (2018) Tracking cancer evolution reveals constrained routes to metastases: TRACERx Renal. Cell. 173:581–594.e12. https://doi.org/10.1016/j.cell.2018.03.057CrossRef

35.

van Ommen F, de Jong H, Dankbaar JW, Bennink E, Leiner T, Schilham AMR (2019) Dose of CT protocols acquired in clinical routine using a dual-layer detector CT scanner: a preliminary report. Eur J Radiol 112:65–71. https://doi.org/10.1016/j.ejrad.2019.01.011CrossRef

36.

Mileto A, Allen BC, Pietryga JA (2017) Characterization of incidental renal mass with dual-energy CT: diagnostic accuracy of effective atomic number maps for discriminating nonenhancing cysts from enhancing masses. 209:W221-230. AJR Am J Roentgenol. https://doi.org/10.2214/AJR.16.17325

37.

Main JR, Donskov F, Pedersen EM, Madsen HHT, Rasmussen F (2014) Dynamic contrast-enhanced computed tomography as a potential biomarker in patients with metastatic renal cell carcinoma: preliminary results from the Danish Renal Cancer Group Study-1. Invest Radiol 49:601–607. https://doi.org/10.1097/RLI.0000000000000058CrossRef

38.

Mains JR, Donskov F, Pedersen EM, Madsen HHT, Rasmussen F (2017) Dynamic contrast-enhanced computed tomography-derived blood volume and blood flow correlate with patient outcome in metastatic renal cell carcinoma. Invest Radiol 52:103–110. https://doi.org/10.1097/RLI.0000000000000315CrossRef

39.

Mains JR, Donskov F, Pedersen EM et al (2018) Use of patient outcome endpoints to identify the best functional CT imaging parameters in metastatic renal cell carcinoma patients. Br J Radiol 91:20160795. https://doi.org/10.1259/bjr.20160795CrossRef

40.

Dobbin SJH, Petrie MC, Myles RC, Touyz RM, Lang NN (2021) Cardiotoxic effects of angiogenesis inhibitors. Clin Sci 135:71–100. https://doi.org/10.1042/CS20200305CrossRef

41.

Zhang JC, Chen WD, Alvarez JB et al (2018) Cancer immune checkpoint blockade therapy and its associated autoimmune cardiotoxicity. Acta Pharmacol Sin 39:1693–1698. https://doi.org/10.1038/s41401-018-0062-2CrossRef

42.

Bae KT (2010) Intravenous contrast medium administration and scan timing at CT: considerations and approaches. Radiology. 256:32–61. https://doi.org/10.1148/radiol.10090908CrossRef

Titel: Early reduction in spectral dual-layer detector CT parameters as favorable imaging biomarkers in patients with metastatic renal cell carcinoma
verfasst von: Aska Drljevic-Nielsen
Jill R. Mains
Kennet Thorup
Michael Brun Andersen
Finn Rasmussen
Frede Donskov
Publikationsdatum: 05.05.2022
Verlag: Springer Berlin Heidelberg
Erschienen in: European Radiology / Ausgabe 11/2022
Print ISSN: 0938-7994
Elektronische ISSN: 1432-1084
DOI: https://doi.org/10.1007/s00330-022-08793-5

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Early reduction in spectral dual-layer detector CT parameters as favorable imaging biomarkers in patients with metastatic renal cell carcinoma

Abstract

Objectives

Methods

Results

Conclusions

Key Points

Neu im Fachgebiet Radiologie

Fünf Dinge, die im Kindernotfall besser zu unterlassen sind

Wie toxische Männlichkeit der Gesundheit von Männern schadet

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Quantitative Angiografie könnte IVUS-Alternative darstellen

Update Radiologie

Live-Webinar: Aktuelle Leitlinien bei Herz-Kreislauf-Erkrankungen

Springer Medizin

Abstract

Objectives

Methods

Results

Conclusions

Key Points

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