title: Metastatic renal carcinoma: evaluation of antiangiogenic therapy with dynamic contrast-enhanced CT.
abstract: OBJECTIVE
  To determine whether tumor perfusion parameters assessed by using dynamic contrast material-enhanced computed tomography (CT) could help predict and detect response in patients receiving antiangiogenic therapy for metastatic renal cell carcinoma.
  
  
  METHODS
  Institutional ethics committee approval and informed consent were obtained. In two phase-III trials involving 51 patients with metastatic renal cell carcinoma (38 men, 13 women; age range, 30-80 years) receiving antiangiogenic drugs (sorafenib [n = 10], sunitinib [n = 22]), a placebo (n = 12), or interferon alfa (n = 7), serial dynamic contrast-enhanced CT was performed, during 90 seconds before and after injection of 80 mL of iobitridol. Perfusion parameters of a target metastatic tumor (tumor blood flow [TBF], tumor blood volume [TBV], mean transit time, and vascular permeability-surface area product) were calculated. Values before and after treatment were compared by using a Wilcoxon signed rank test, and relative changes in groups were compared by using the Wilcoxon rank sum test. Results were compared with Response Evaluation Criteria in Solid Tumors response and with progression-free and overall survival by using Kaplan-Meier curves.
  
  
  RESULTS
  Among patients receiving antiangiogenic drugs, baseline perfusion parameters were higher in responders than in stable patients (TBF = 245.3 vs 119.5 mL/min/100 mL, P = .04; TBV = 15.5 vs 8.2 mL/100 mL, P = .02) but were not significantly predictive of survival. After the first cycle of treatment, there was a significant decrease in TBF (162.5 vs 76.7 mL/min/100 mL, P = .0002) and TBV (9.1 vs 3.9 mL/100 mL, P < .0001) in patients receiving antiangiogenic treatment.
  
  
  CONCLUSIONS
  Renal carcinoma perfusion parameters determined with dynamic contrast-enhanced CT can help predict biologic response to antiangiogenic drugs before beginning therapy and help detect an effect after a single cycle of treatment.
authors.affiliation: Department of Radiology, Assistance Publique-Hôpitaux de Paris, Hôpital Européen Georges Pompidou, 20 rue Leblanc, Paris 75015, France. laure.fournier@egp.aphp .fr
authors.forename: Laure S
authors.initials: LS
authors.lastname: Fournier
authors.forename: Stephane
authors.initials: S
authors.lastname: Oudard
authors.forename: Rokhaya
authors.initials: R
authors.lastname: Thiam
authors.forename: Ludovic
authors.initials: L
authors.lastname: Trinquart
authors.forename: Eugeniu
authors.initials: E
authors.lastname: Banu
authors.forename: Jacques
authors.initials: J
authors.lastname: Medioni
authors.forename: Daniel
authors.initials: D
authors.lastname: Balvay
authors.forename: Gilles
authors.initials: G
authors.lastname: Chatellier
authors.forename: Guy
authors.initials: G
authors.lastname: Frija
authors.forename: Charles A
authors.initials: CA
authors.lastname: Cuenod
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D020533:Angiogenesis Inhibitors / Q000008:administration & dosage*; D001557:Benzenesulfonates / Q000008:administration & dosage*; D002292:Carcinoma, Renal Cell / Q000000981:diagnostic imaging / Q000188:drug therapy / Q000556:secondary; D005260:Female; D006801:Humans; D007211:Indoles / Q000008:administration & dosage*; D007680:Kidney Neoplasms / Q000000981:diagnostic imaging / Q000188:drug therapy / Q000556:secondary; D008297:Male; D008875:Middle Aged; D009536:Niacinamide / Q000031:analogs & derivatives; D010671:Phenylurea Compounds; D011379:Prognosis; D011725:Pyridines / Q000008:administration & dosage*; D011758:Pyrroles / Q000008:administration & dosage*; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D000077157:Sorafenib; D000077210:Sunitinib; D014057:Tomography, X-Ray Computed / Q000379:methods*; D016896:Treatment Outcome
chemical_list: D020533:Angiogenesis Inhibitors; D001557:Benzenesulfonates; D007211:Indoles; D010671:Phenylurea Compounds; D011725:Pyridines; D011758:Pyrroles; D009536:Niacinamide; D000077157:Sorafenib; D000077210:Sunitinib