Current Challenges in Diagnosis and Assessment of the Response of Locally Advanced and Metastatic Renal Cell Carcinoma

• Published in: Radiographics Vol. 39; no. 4; pp. 998 - 1016
• Main Authors: Diaz de Leon, Alberto, Pirasteh, Ali, Costa, Daniel N, Kapur, Payal, Hammers, Hans, Brugarolas, James, Pedrosa, Ivan
• Format: Journal Article
• Language: English
• Published: United States Radiological Society of North America 01-07-2019
• Subjects: Antineoplastic Agents - adverse effects; Antineoplastic Agents - therapeutic use; Bone Neoplasms - diagnostic imaging; Bone Neoplasms - secondary; Carcinoma, Renal Cell - classification; Carcinoma, Renal Cell - diagnosis; Carcinoma, Renal Cell - diagnostic imaging; Carcinoma, Renal Cell - secondary; Combined Modality Therapy; Female; Gastrointestinal Diseases - chemically induced; Gastrointestinal Diseases - diagnostic imaging; Gastrointestinal Neoplasms - diagnostic imaging; Gastrointestinal Neoplasms - secondary; Genitourinary Imaging; Humans; Kidney Neoplasms - diagnosis; Kidney Neoplasms - diagnostic imaging; Kidney Neoplasms - pathology; Kidney Neoplasms - therapy; Leiomyoma - diagnostic imaging; Lung Diseases - chemically induced; Lung Diseases - diagnostic imaging; Lymphatic Metastasis; Magnetic Resonance Imaging; Neoplasm Invasiveness; Neoplasm Metastasis; Neoplasms, Multiple Primary - diagnostic imaging; Nephrectomy; Pancreatic Neoplasms - diagnostic imaging; Pancreatic Neoplasms - secondary; Practice Guidelines as Topic; Tomography, X-Ray Computed - methods; Uterine Neoplasms - diagnostic imaging
• ISSN: 0271-5333; 1527-1323
• DOI: 10.1148/rg.2019180178

Locally advanced and metastatic renal cell carcinoma (RCC) present a specific set of challenges to the radiologist. The detection of metastatic disease is confounded by the ability of RCC to metastasize to virtually any part of the human body long after surgical resection of the primary tumor. This includes sites not commonly included in routine surveillance, which come to light after the patient becomes symptomatic. In the assessment of treatment response, the phenomenon of tumor heterogeneity, where clone selection through systemic therapy drives the growth of potentially more aggressive phenotypes, can result in oligoprogression despite overall disease control. Finally, advances in therapy have resulted in the development of immuno-oncologic agents that may result in changes that are not adequately evaluated with conventional size-based response criteria and may even be misinterpreted as progression. This article reviews the common challenges a radiologist may encounter in the evaluation of patients with locally advanced and metastatic RCC.
RSNA, 2019.