Keywords:
Abdomen, Kidney, Oncology, CT, Treatment effects, Neoplasia
Authors:
A. D. Sotomayor1, B. Paño Brufau2, J. M. Gutiérrez1, B. Mellado2, O. Reig2, M. C. Sebastia2; 1Barcelona, Barcelona/ES, 2Barcelona/ES
DOI:
10.1594/ecr2013/C-1596
Results
From March 2011 to May 2012,
16 patients were included.
Most of the patients had clear cell carcinoma (n=13,
81.25%) and good prognosis (n=14,
87.5%),
based on the Motzer and Heng criteria.
Descriptive baseline characteristics of the patients are summarized in Table 1.
CT scans at one and four months were performed in 14 and 12 patients,
respectively,
as described in Figure 1.
Two patients were lost before the 4 month CT follow-up.
Although initially six patterns were described,
at the final analysis we established 4 clearly defined patterns according to changes in size,
density and perfusion parameters at the first month CT.
- Pattern 1: Decrease in tumour size (S),
density (D) and blood flow (BF).
(Figure 2)
- Pattern 2: Stable S and decrease in D and BF.
(Figure 3)
- Pattern 3: Increase in S,
and decrease of D and BF.
(Figure 4)
- Pattern 4: Increase in D or BF with decrease,
stability or increase in size.
(Figure 5 and 6)
Eleven patients exhibited a decrease in D and BF (pattern 1 to 3).
All the patients with decrease in D and BF,
irrespective of whether they had changes in tumour size,
showed partial response (n=8) or stable disease (n=2) at the 4 month CT or longer.
The increase in S,
associated with a decrease in BF and D (pattern 3),
was associated with hemorrhagic necrosis and it should not be confused with disease progression.
Pattern 3 was found in only 2 patients (12.5%).
In both patients,
the changes in D and BF preceded the changes in S.
The increase in D and BF (pattern 4) irrespective of the changes in S,
(n=3) are refractory or early or slow progressors.
See figure 7.
Table 2 shows the changes in size,
density and BF fo the four patterns in average with correlation with 4 months RECIST results.
As nine of the patients (56.25%) continue with the treatment,
we cannot correlate perfusion-CT patterns with the long-term response or survival data.