title: CT quantification of effects of thalidomide in patients with metastatic renal cell carcinoma.
abstract: OBJECTIVE
  Our objective was to use functional CT to evaluate the effects of thalidomide in patients with metastatic renal cell carcinoma.
  
  
  METHODS
  Patients with proven metastatic renal cell carcinoma were examined prospectively with functional CT. Functional CT studies (cine mode, 4 x 5 mm) were performed through the tumor after i.v. administration of a bolus of contrast material before and every 12 weeks after treatment with thalidomide. Quantitative values for blood flow, blood volume, mean transit time, and permeability-surface area product were calculated with commercial software. The average difference in percentage change in functional CT parameters from pretreatment to 12 and 24 weeks after treatment and the median difference in percentage change in functional CT parameters between response groups were assessed. We also tested whether percentage changes in functional CT parameters 12 weeks after treatment correlated with time to progression of disease and size of the perfused lesion.
  
  
  RESULTS
  Sixteen patients with a total of 23 tumors underwent at least one follow-up functional CT examination. Blood flow, blood volume, and permeability-surface area product decreased significantly 12 weeks (-18%, p = 0.0039; -15%, p = 0.0350; -24%, p = 0.0010) and 24 weeks (-28%, p = 0.017; -19%, p = 0.0300; -25%, p = 0.0031) after treatment with thalidomide. Time to progression correlated significantly with percentage change in blood flow (r = -0.34; p = 0.040) and permeability-surface area product (r = -0.36, p = 0.023) at 12 weeks. Responders had a significantly larger decrease in blood flow 12 weeks after treatment than did nonresponders (-29% vs -6%; p = 0.032). We also found a significant correlation between decrease in size of the perfused lesion and percentage decrease in blood flow 12 weeks after treatment (r = 0.50; p = 0.019).
  
  
  CONCLUSIONS
  Changes in functional CT parameters 12 weeks after treatment may be useful for monitoring the effects of thalidomide and predicting treatment outcome among patients with metastatic renal cell carcinoma. Further study with a larger clinical trial is needed.
authors.affiliation: Department of Diagnostic Radiology, The University of Texas M. D. Anderson Cancer Center, Houston, TX, USA. fariasil@hotmail.com
authors.forename: Silvana C
authors.initials: SC
authors.lastname: Faria
authors.forename: Chaan S
authors.initials: CS
authors.lastname: Ng
authors.forename: Kenneth R
authors.initials: KR
authors.lastname: Hess
authors.forename: Sith
authors.initials: S
authors.lastname: Phongkitkarun
authors.forename: Jacob
authors.initials: J
authors.lastname: Szejnfeld
authors.forename: Danai
authors.initials: D
authors.lastname: Daliani
authors.forename: Chusilp
authors.initials: C
authors.lastname: Charnsangavej
mesh_terms: D000328:Adult; D000368:Aged; D020533:Angiogenesis Inhibitors / Q000627:therapeutic use*; D002292:Carcinoma, Renal Cell / Q000000981:diagnostic imaging* / Q000188:drug therapy* / Q000556:secondary; D003287:Contrast Media; D018450:Disease Progression; D005260:Female; D006801:Humans; D007680:Kidney Neoplasms / Q000473:pathology*; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D011857:Radiographic Image Interpretation, Computer-Assisted; D018709:Statistics, Nonparametric; D013792:Thalidomide / Q000627:therapeutic use*; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome
chemical_list: D020533:Angiogenesis Inhibitors; D003287:Contrast Media; D013792:Thalidomide