Magnetic resonance spectroscopic imaging (1H-MRSI) and dynamic contrast-enhanced magnetic resonance (DCE-MRI): pattern changes from inflammation to prostate cancer.

PURPOSE: To assess (1)H-magnetic resonance spectroscopic imaging ((1)H-MRSI) and dynamic contrast-enhanced magnetic resonance (DCE-MRI) features in histologically confirmed prostatic chronic inflammation, prostatic intraepithelial neoplasia (PIN), low grade prostate cancer (LGPCa), and high grade prostate cancer (HGPCa). MATERIALS AND METHODS: Ninety-six men were selected, who showed at histology a diagnosis of chronic inflammation (Group B), high grade (HG) PIN (Group C), or prostate cancer (LGPCa = Group D and HGPCa = Group E). RESULTS: ANOVA analysis shows that inflammation (Group B) displays no significantly (p >.05) different choline and citrate levels when compared to HGPIN and LGPCa. CONCLUSION: our results suggest the potential for these MR imaging techniques in the description of inflammatory and proliferative lesions inside the prostate gland.

Neoadjuvant therapy with sorafenib in advanced renal cell carcinoma with vena cava extension submitted to radical nephrectomy.

A 71-year-old man with advanced left renal cell carcinoma (lymph node involvement and vena cava thrombus) was submitted to 6 months of neoadjuvant treatment with sorafenib before open radical nephrectomy. After sorafenib treatment and before surgery a new CT scan confirmed the presence of a 9.0 cm in diameter solid mass in the left kidney but a reduction in thrombus extension, limited to the left renal vein. At histological examination after radical nephrectomy, over 90% of the renal mass was substituted by necrotic tissue.

The emerging role of targeted therapy in renal cell carcinoma (RCC): is it time for a neoadjuvant or an adjuvant approach?

PURPOSE: We address whether rational and significant clinical data exist on using angiogenic targeted therapies as neoadjuvant or adjuvant options to nephrectomy in non-metastatic RCC. METHODS: We reviewed the recent international literature by carrying out a PUBMED search. RESULTS: Neoadjuvant: a possible indication for a neoadjuvant targeted therapy approach is to facilitate surgery, reducing risks for patients and increasing the possibility of removing the mass and improving oncological results. Adjuvant: three major phase III clinical trials are currently ongoing. The ASSURE trial (1 year on oral sunitinib, sorafenib or placebo), the SORCE trial (3 years on placebo versus 1 year on sorafenib, followed by 2 years on placebo versus 3 years on sorafenib), and the S-TRAC trial (1 year on sunitinib or placebo) analyze patients who are at high risk of relapse. CONCLUSIONS: Rationale and needs for the neoadjuvant or adjuvant use of targeted therapies in RCC are relevant. Significant phase III trials on the adjuvant use of targeted therapy in RCC are ongoing.

Determination of the time for maximal response to neoadjuvant hormone therapy for prostate cancer using magnetic resonance with spectroscopy (MRSI) and dynamic contrast enhancement (DCEMR).

PURPOSE: To determine the time-dependent metabolic and angiogenic changes that occur in prostate cancer (CaP) during neoadjuvant hormone therapy (HT), using a combination of MRSI and DCEMR analysis. MATERIALS AND METHODS: This is a prospective study on a population of non-metastatic CaP submitted to neoadjuvant HT prior to radiation therapy. All cases homogeneously received a 6-month period of neoadjuvant HT using leuprorelin acetate 7.5 mg every 28 days. In all cases, a MRSI/DCEMR study was performed at baseline (pretreatment) and at regular intervals (4, 12, 24 weeks) during HT. Serum PSA was measured at baseline and at the same intervals (4, 12, 24 weeks). All MRI examinations were performed on a commercially available 3 T scanner. RESULTS: There was a significant ( P < 0.01) time-dependent loss of all prostate metabolites during HT. In regions of CaP no significant variation in the absolute value of metabolites was reported at 1-month interval and a higher variation was observed at 24-week compared with 12-week interval. A complete metabolic atrophy was a common feature (30%) at a 24-week interval of HT, but not at short (4-week 0%), and lower at an intermediate interval (12-week 10%). At DCEMR, onset time and time to peak parameters significantly (P < 0.05) increased at 12- and 24-week intervals. CONCLUSIONS: To individualize neoadjuvant HT courses prior to definitive treatment, the combination of MRSI and DCEMR may represent a valid noninvasive method, and the addition to PSA data could be used to better assess the time-dependent efficacy of HT in our patients.

Adjuvant therapy with sorafenib in bone metastases bilateral renal carcinoma: a case report.

A 69-yr-old man with bilateral and metastatic renal cell carcinoma developed progressive disease after interleukin-2 and interferon therapy. He was submitted to radical left nephrectomy, right nephron-sparing surgery, and bone metastasis removal, followed by therapy with sorafenib. At 12-mo follow-up there was a significant improvement in patient performance status and no evidence of clinical progression.