|LETTER TO EDITOR
|Year : 2014 | Volume
| Issue : 3 | Page : 390
Response assessment to Sunitinib by F-18 Fluorodeoxyglucose PET/CT in a case of venous tumor thrombosis from renal cell carcinoma
K Manohar1, BR Mittal1, K Agrawal1, R Kashyap1, A Bhattacharya1, AK Mandal2
1 Department of Nuclear Medicine and PET, Postgraduate Institute of Medical Education and Research, Chandigarh, India
2 Department of Urology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
|Date of Web Publication||10-Dec-2014|
Prof. B R Mittal
Department of Nuclear Medicine and PET, Postgraduate Institute of Medical Education and Research, Chandigarh
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Manohar K, Mittal B R, Agrawal K, Kashyap R, Bhattacharya A, Mandal A K. Response assessment to Sunitinib by F-18 Fluorodeoxyglucose PET/CT in a case of venous tumor thrombosis from renal cell carcinoma. Indian J Cancer 2014;51:390
|How to cite this URL:|
Manohar K, Mittal B R, Agrawal K, Kashyap R, Bhattacharya A, Mandal A K. Response assessment to Sunitinib by F-18 Fluorodeoxyglucose PET/CT in a case of venous tumor thrombosis from renal cell carcinoma. Indian J Cancer [serial online] 2014 [cited 2020 Jul 8];51:390. Available from: http://www.indianjcancer.com/text.asp?2014/51/3/390/146770
F-18 Fluorodeoxyglucose (FDG) PET/CT has been shown to be useful in restaging, surveillance, and demonstration of unusual sites of metastases in patients with renal cell carcinoma.  We describe here a case of isolated tumor thrombosis of Inferior Vena Cava (IVC), in which F-18 FDG PET/CT was useful in predicting response to treatment to tyrosine kinase inhibitor sunitinib. A 49-year-old male patient underwent right radical nephrectomy was noted to have inferior vena caval tumor thrombus with invasion of wall intra-operatively. Tumor thrombus was unresectable due to IVC wall invasion. Patient was subjected to F-18 FDG PET/CT scan for restaging of disease and to identify the extent of tumor thrombus. Significant FDG uptake (SUVmax = 7.2) above liver background was noticed in tumor thrombus involving the entire intra- and infra-hepatic IVC and bilateral common iliac and bilateral external iliac veins. No abnormal FDG uptake was noted in rest of the body. Patient was started on sunitinib treatment, and repeat F-18 FDG PET/CT scan was done after 3 cycles of 21-day therapy. Interim FDG PET/CT was interpreted according to EORTC criteria for response assessment, and the scan showed decrease in SUVmax of tumor thrombus from 7.2 to 5.2 (decrease of 27%) coupled with visible reduction of uptake to less than liver background in greater than 50% extent of involvement (infra-hepatic IVC and bilateral iliac veins), compared to baseline scan fitting into partial response category according to EORTC criteria.  However, filling defect persisted on contrast CT images. This partial response on F-18 FDG PET/CT correlated well with prognosis of the patient, as patient remained progression-free till the last follow-up at 9 months. Tyrosine kinase inhibitors have shown to prolong the survival conventional response assessment criteria like RECIST.  SHARP trial is one of the landmark study, which highlighted the failure of anatomical response criteria in assessment of response to tyrosine kinase inhibitors.  Few studies with F18-FDG PET/CT have elucidated the potential role of F18-FDG PET/CT in assessment of response in this group of patients and making meaningful assessment of response with good correlation with progression-free survival.  As demonstrated in our case, probably the first in our knowledge, F-18 FDG PET/CT was able to predict response and progression-free survival in isolated tumor venous thrombosis in renal cell carcinoma. Metrics of SUVmax reduction of 25% and measurement of length of involvement using F-18 FDG PET/CT as described by EORTC criteria can be a useful methodology to assess response to therapy early in case of tumor venous thromboses as there are no clear guidelines to assess response to chemotherapy in tumor venous thromboses. [Figure 1]
|Figure 1: (a) Pre-therapy coronal CeCT and FDG PET/CT images showing filling defect and increased FDG uptake (SUVmax = 7.2) in entire intra and infra-hepatic IVC and bilateral common iliac veins. (b) Post-therapy coronal FDG PET/CT images showing decrease in SUVmax of tumor thrombus from 7.2 to 5.2 (decrease of 27%) coupled with visible reduction of uptake to less than liver background in infra-hepatic IVC and bilateral iliac veins while filling defect persisted on CeCT images|
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| » References|| |
Kumar R, Shandal V, Shamim SA, Jeph S, Singh H, Malhotra A. Role of FDG PET-CT in recurrent renal cell carcinoma. Nucl Med Commun 2010;31:844-50.
Young H, Baum R, Cremerius U, Herholz K, Hoekstra O, Lammertsma AA, et al.
Measurement of clinical and subclinicaltumour response using [18 F]-fluorodeoxyglucose and positron emission tomography: Review and 1999 EORTC recommendations. European Organizationfor Research and Treatment of Cancer (EORTC) PET Study Group. Eur J Cancer 1999;35:1773-82.
Forner A, Ayuso C, Varela M, Rimola J, Hessheimer AJ, de Lope CR et al.
Evaluation of tumor response after locoregional therapies in hepatocellular carcinoma: Are response evaluation criteria in solid tumors reliable? Cancer 2009;115:616-23.
Llovet JM, Ricci S, Mazzaferro V, Hilgard P, Gane E, Blanc JF et al.
Sorafenib in advanced hepatocellular carcinoma. N Engl J Med 2008;359:378-90.
Sunaga N, Oriuchi N, Kaira K, Yanagitani N, Tomizawa Y, Hisada T et al.
Usefulness of FDG-PET for early prediction of the response to gefitinib in non-small cell lung cancer Lung Cancer 2008;59:203-10.