Abstract
The incidence of early and advanced-stage renal cell carcinoma (RCC) is increasing. Methods of diagnosing, staging and evaluating tumor burden that are more accurate and reliable than the currently available options are needed in order to identify RCC at a stage at which it is curable and to accurately determine the response to treatment. Functional imaging, particularly with combined PET–CT, might improve accuracy of detection and provide essential information that has been unavailable to date. This approach is against a background in which targeted therapies for metastatic RCC have entered clinical practice in the past few years, further highlighting the importance of accurate imaging for patient selection and for monitoring response to treatment. We outline the current clinical status of functional imaging in RCC using PET–CT, which allows simultaneous capture and co-registration of functional and anatomical data. New radiotracers and approaches—including radiolabeled monoclonal antibodies and imaging of tumor hypoxia—are touched on, and areas of future research discussed.
Key Points
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There is evidence to support a role for functional imaging using 18F-FDG-PET–CT in initial staging and re-staging of relapsing or metastatic renal cell carcinoma
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Diagnostic 18F-FDG-PET–CT has limitations, but its utility might be enhanced by using immuno-PET (for example, 124I-cG250-PET–CT) or other radiolabeled molecules
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Functional imaging could optimize monitoring of responses to newer therapies (for example, tyrosine kinase inhibitors), and facilitate more directed allocation of patients to the most appropriate treatments
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New radiopharmaceuticals—for bone metastases, for example—are being developed, but confirmatory data are required
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Acknowledgements
We thank Lorraine Trecroce, a student from the Division of Biomedical Communications, University of Toronto, Canada, for creating the original artwork on which Figure 1 is based. N. Lawrentschuk is supported in part by a grant from The University of Toronto, Princess Margaret Hospital Campbell Family Trust, Surgical Oncology Fellowship, Toronto, Canada. I. D. Davis is supported in part by a Victorian Cancer Agency Clinical Researcher Fellowship, and is an Australian National Health and Medical Research Council Honorary Practitioner Fellow.
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Lawrentschuk, N., Davis, I., Bolton, D. et al. Functional imaging of renal cell carcinoma. Nat Rev Urol 7, 258–266 (2010). https://doi.org/10.1038/nrurol.2010.40
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DOI: https://doi.org/10.1038/nrurol.2010.40
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