Umberto Capitanio1, Gino Pepe2, Elena Incerti2, Alessandro Larcher3, Francesco Trevisani3, Roberta Lucianò4, Paola Mapelli2,5, Valentino Bettinardi2, Cristina Monterisi2, Andrea Necchi6, Stefano Cascinu5,7, Rosa Bernardi8, Roberto Bertini3, Claudio Doglioni4,5, Luigi Gianolli2, Andrea Salonia3,5, Maria Picchio2,5, Francesco Montorsi3,5. 1. Unit of Urology, Division of Experimental Oncology, Urological Research Institute (URI), IRCCS San Raffaele Scientific Institute, Via Olgettina 60, 20132, Milan, Italy. capitanio.umberto@hsr.it. 2. Unit of Nuclear Medicine, IRCCS San Raffaele Scientific Institute, Milan, Italy. 3. Unit of Urology, Division of Experimental Oncology, Urological Research Institute (URI), IRCCS San Raffaele Scientific Institute, Via Olgettina 60, 20132, Milan, Italy. 4. Unit of Pathology, IRCCS San Raffaele Scientific Institute, Milan, Italy. 5. School of Medicine, Vita-Salute San Raffaele University, Milan, Italy. 6. Unit of Oncology, IRCCS Istituto dei Tumori, Milan, Italy. 7. Unit of Oncology, IRCCS San Raffaele Scientific Institute, Milan, Italy. 8. Division of Experimental Oncology, IRCCS San Raffaele Scientific Institute, Milan, Italy.
Abstract
BACKGROUND: The accurate detection of nodal invasion is an unmet need in the clinical staging of renal cancer. Positron emission tomography (PET) with 18F-fluoroazomycin arabinoside (18F-FAZA), a hypoxia specific tracer, is a non-invasive imaging method that detects tumour hypoxia. The aim of this work was to evaluate the role of 18F-FAZA PET/CT in the identification of lymph node metastases in renal cancer. METHODS: A proof-of-concept phase 2 study including 20 kidney cancer patients ( ClinicalTrials.gov Identifier: NCT03955393) was conducted. Inclusion criteria were one or more of the following three criteria: (1) clinical tumour size > 10 cm, (2) evidence of clinical lymphadenopathies at preoperative CT scan and (3) clinical T4 cancer. Before surgery, 18F-FAZA PET/CT was performed, 2 h after the intravenous injection of the radiotracer. An experienced nuclear medicine physician, aware of patient's history and of all available diagnostic imaging, performed a qualitative and semi-quantitative analysis on 18F-FAZA images. Histopathological analysis was obtained in all patients on surgical specimen. RESULTS: Fourteen/19 (74%) patients had a non-organ confined renal cell carcinoma (RCC) at final pathology (either pT3 or pT4). Median number of nodes removed was 12 (IQR 7-15). The rate of lymph node invasion was 16%. No patient with pN1 disease showed positive 18F-FAZA PET, thus suggesting the non-hypoxic behaviour of the lesions. In addition, neither primary tumour nor distant metastases presented a pathological 18F-FAZA uptake. No adverse events were recorded during the study. CONCLUSIONS: 18F-FAZA PET/CT scan did not detect RCC lymph neither nodal nor distant metastases and did not show any uptake in the primary renal tumour.
BACKGROUND: The accurate detection of nodal invasion is an unmet need in the clinical staging of renal cancer. Positron emission tomography (PET) with 18F-fluoroazomycin arabinoside (18F-FAZA), a hypoxia specific tracer, is a non-invasive imaging method that detects tumour hypoxia. The aim of this work was to evaluate the role of 18F-FAZA PET/CT in the identification of lymph node metastases in renal cancer. METHODS: A proof-of-concept phase 2 study including 20 kidney cancerpatients ( ClinicalTrials.gov Identifier: NCT03955393) was conducted. Inclusion criteria were one or more of the following three criteria: (1) clinical tumour size > 10 cm, (2) evidence of clinical lymphadenopathies at preoperative CT scan and (3) clinical T4 cancer. Before surgery, 18F-FAZA PET/CT was performed, 2 h after the intravenous injection of the radiotracer. An experienced nuclear medicine physician, aware of patient's history and of all available diagnostic imaging, performed a qualitative and semi-quantitative analysis on 18F-FAZA images. Histopathological analysis was obtained in all patients on surgical specimen. RESULTS: Fourteen/19 (74%) patients had a non-organ confined renal cell carcinoma (RCC) at final pathology (either pT3 or pT4). Median number of nodes removed was 12 (IQR 7-15). The rate of lymph node invasion was 16%. No patient with pN1 disease showed positive 18F-FAZA PET, thus suggesting the non-hypoxic behaviour of the lesions. In addition, neither primary tumour nor distant metastases presented a pathological 18F-FAZA uptake. No adverse events were recorded during the study. CONCLUSIONS:18F-FAZA PET/CT scan did not detect RCC lymph neither nodal nor distant metastases and did not show any uptake in the primary renal tumour.
Authors: Morand Piert; Hans-Jürgen Machulla; Maria Picchio; Gerald Reischl; Sybille Ziegler; Piyush Kumar; Hans-Jürgen Wester; Roswitha Beck; Alexander J B McEwan; Leonard I Wiebe; Markus Schwaiger Journal: J Nucl Med Date: 2005-01 Impact factor: 10.057