ABSTRACT
INTRODUCTION: We evaluate volumetry and RECIST (Response Evaluation Criteria In Solid Tumors) as methodologies for response after chemotherapy for non-seminomatous germ cell tumour with retroperitoneal lymph node metastases. METHODS: We performed a retrospective analysis of non-seminomatous testicular tumours and concurrent retroperitoneal lymph node metastases, which received chemotherapy and had computed tomography scans before and after treatment. Volumetric analysis and RECIST criteria were used to calculate response rates. We included a new category (favourable response) for patients with response rates between <100% and >70%. We calculated the correlation between volumetric and RECIST criteria with histological and clinical variables. RESULTS: In total, 18 patients met the inclusion criteria. Histopathologic analysis of orchiectomy showed teratoma in 55.5% of patients, and those without teratoma had predominantly embryonal carcinoma. The mean baseline volume of retroperitoneal metastases was 447 cc, the mean post-chemotherapy volume was 33.6 cc, and the response rate was 62.6%. According to RECIST criteria, the mean baseline diameter was 4.93 cm, the mean post-chemotherapy diameter was 2.39 cm, and the response rate was 42.4%. Large post-chemotherapy residual masses correlated in both classifications with teratoma. The response rate was associated with the need for surgical treatment and the volumetric classification correlated with the need for lymphadenectomy. CONCLUSIONS: This study evaluated volumetry as a way to measure clinical response in lymph node metastases of non-seminomatous germ cell tumours. Volumetric analysis is the next step in the evaluation of response rate; its accuracy remains to be determined. Teratoma had greater residual masses and our classification correlated with the need for lymphadenectomy.
ABSTRACT
PURPOSE: Areas of lower enhancement on computed tomography are frequently seen in renal-cell carcinoma. We investigated whether tumor enhancement on the most prominent hypodense areas correlates with the nuclear grade and other pathologic variables. METHODS: From 2004 to 2009, all consecutive patients with a preoperative tomography who underwent radical or partial nephrectomy for renal-cell carcinoma at our tertiary referral center were retrospectively analyzed. Enhancement of the entire tumor on the slice with most prominent areas of lower enhancement was determined. RESULTS: Forty-eight patients were included. Clear-cell carcinoma comprised 91.6 %. Mean areas of lower enhancement for nuclear grade tumors 1-4 were 67.4, 38.7, 27.9, and 15.1 HU, respectively. Areas of lower enhancement negatively correlated with size, nuclear grade, T stage, and pathological stage. Tumors with extension beyond Gerota's fascia (10.5 vs. 35.9 HU, p < 0.001) and positive surgical margins (21.2 vs. 34.8 HU, p = 0.04) had more prominent areas of lower enhancement than organ-confined tumors. When comparing nuclear grade 1-3 to nuclear grade 4 tumors, these areas were significantly lower in the later (36.5 vs. 15.1 HU, p < 0.001). Receiver-operating characteristics curves for detecting nuclear grade 4 showed an area under the curve of 0.808 (95 % CI 0.659-0.957). CONCLUSIONS: Lower enhancement of the entire tumor at the point where hypodense tumor areas are more predominant on tomography is associated with higher nuclear grade and more advanced stage.
