CT Quantification of Effects of Thalidomide in Patients with Metastatic Renal Cell Carcinoma
Silvana C. Faria1,2,
Chaan S. Ng1,
Kenneth R. Hess3,
Sith Phongkitkarun1,4,
Jacob Szejnfeld5,
Danai Daliani6 and
Chusilp Charnsangavej1
1 Department of Diagnostic Radiology, The University of Texas M. D. Anderson
Cancer Center, Houston, TX.
2 Present address: Department of Radiology, The University of California at San
Diego, 200 W Arbor Dr., San Diego, CA 92103-8755.
3 Department of Biostatistics and Applied Mathematics, The University of Texas
M. D. Anderson Cancer Center, Houston, TX.
4 Present address: Department of Radiology, Faculty of Medicine, Ramathibodi
Hospital, Bangkok, Thailand.
5 Department of Diagnostic Radiology, The Federal University of Sao Paulo, Sao
Paulo, Brazil.
6 Department of Genitourinary Medical Oncology, The University of Texas M. D.
Anderson Cancer Center, Houston, TX.
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Fig. 1A —58-year-old man with metastatic renal cell carcinoma. Axial
contrast-enhanced CT images obtained with CT perfusion software before
treatment (A) and after 12 weeks (B) and 24 weeks (C) of
thalidomide treatment. Regions of interest were placed within aorta to define
arterial input and drawn freehand around metastatic lesion of renal cell
carcinoma (arrow) in liver.
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Fig. 1B —58-year-old man with metastatic renal cell carcinoma. Axial
contrast-enhanced CT images obtained with CT perfusion software before
treatment (A) and after 12 weeks (B) and 24 weeks (C) of
thalidomide treatment. Regions of interest were placed within aorta to define
arterial input and drawn freehand around metastatic lesion of renal cell
carcinoma (arrow) in liver.
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Fig. 1C —58-year-old man with metastatic renal cell carcinoma. Axial
contrast-enhanced CT images obtained with CT perfusion software before
treatment (A) and after 12 weeks (B) and 24 weeks (C) of
thalidomide treatment. Regions of interest were placed within aorta to define
arterial input and drawn freehand around metastatic lesion of renal cell
carcinoma (arrow) in liver.
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Fig. 1D —58-year-old man with metastatic renal cell carcinoma. Color blood
flow functional maps corresponding to A-C show metastatic lesion of
renal cell carcinoma (arrow) in liver. Blood flow decreased
significantly from 233.97 mL/min/100 g before treatment (D) to 145.97
mL/min/100 g at 12 weeks (E) and 134.42 mL/min/100 g at 24 weeks
(F) after thalidomide treatment.
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Fig. 1E —58-year-old man with metastatic renal cell carcinoma. Color blood
flow functional maps corresponding to A-C show metastatic lesion of
renal cell carcinoma (arrow) in liver. Blood flow decreased
significantly from 233.97 mL/min/100 g before treatment (D) to 145.97
mL/min/100 g at 12 weeks (E) and 134.42 mL/min/100 g at 24 weeks
(F) after thalidomide treatment.
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Fig. 1F —58-year-old man with metastatic renal cell carcinoma. Color blood
flow functional maps corresponding to A-C show metastatic lesion of
renal cell carcinoma (arrow) in liver. Blood flow decreased
significantly from 233.97 mL/min/100 g before treatment (D) to 145.97
mL/min/100 g at 12 weeks (E) and 134.42 mL/min/100 g at 24 weeks
(F) after thalidomide treatment.
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Fig. 2 —Graph shows correlation between percentage change in blood flow from
pretreatment (baseline) to 12 weeks after thalidomide treatment and time to
progression in days. r = -0.34; p = 0.040 (statistically
significant).
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Fig. 3 —Graph shows correlation between percentage change in
permeability-surface area product from pretreatment (baseline) to 12 weeks
after thalidomide treatment and time to progression in days. r
=-0.36; p =0.023 (statistically significant).
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Fig. 4 —Graph shows probability of response versus percentage change in
blood flow. We excluded outlier data from one patient who had 439% increase in
blood flow 12 weeks after thalidomide treatment. Solid line indicates
estimated probability; dashed lines, 95% CI.
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Fig. 5 —Graph shows correlation between percentage change in blood flow from
pretreatment (baseline) to 12 weeks after thalidomide treatment and percentage
change in tumor size of 23 metastatic tumors (perfused lesions). r
=0.5; p = 0.019 (statistically significant).
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Fig. 6A —64-year-old man with metastatic renal cell carcinoma. Axial
contrast-enhanced CT images obtained with CT perfusion software show right
hilar metastatic lesion of renal cell carcinoma (arrow). Tumor size
decreased from pretreatment CT scan (A) to CT scan obtained 12 weeks
after start of thalidomide treatment (B).
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Fig. 6B —64-year-old man with metastatic renal cell carcinoma. Axial
contrast-enhanced CT images obtained with CT perfusion software show right
hilar metastatic lesion of renal cell carcinoma (arrow). Tumor size
decreased from pretreatment CT scan (A) to CT scan obtained 12 weeks
after start of thalidomide treatment (B).
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Fig. 6C —64-year-old man with metastatic renal cell carcinoma. Color blood
flow functional maps corresponding to A and B. Blood flow in
right hilar metastatic lesion (arrow) decreased from 353.34
mL/min/100 g before thalidomide treatment (C) to 95.016 mL/min/100 g 12
weeks after treatment (D). Disease remained stable for > 2 years;
patient continued in study for 759 days.
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Fig. 6D —64-year-old man with metastatic renal cell carcinoma. Color blood
flow functional maps corresponding to A and B. Blood flow in
right hilar metastatic lesion (arrow) decreased from 353.34
mL/min/100 g before thalidomide treatment (C) to 95.016 mL/min/100 g 12
weeks after treatment (D). Disease remained stable for > 2 years;
patient continued in study for 759 days.
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