E1653. Metastatic Renal Cell Carcinoma: A Primer on Tumor Response Criteria and Post Treatment Complications
  1. Richard Olmsted; Baylor College of Medicine
  2. Khaled Elsayes; University of Texas MD Anderson Cancer Center
  3. Dhakshinamoorthy Ganeshan; University of Texas MD Anderson Cancer Center
Renal cell carcinomas is among the 10 most common cancers in both men and women. The overall lifetime risk for developing renal malignancy is between 1 to 2% (higher risk in men). It is estimated that there will be over 73,750 new cases of RCC and close to 15,000 renal cancer-related deaths in the United States in 2020. Tumor prognosis is closely related to the stage of the malignancy. The 5-year survival rate in patients with localized RCC is 93% while it is only 12% in those with distant metastases.

Educational Goals / Teaching Points
Review the epidemiology, histopathology, molecular cytogenetics and tumor biology of RCC. Discuss the biological mediators and patterns of metastases in RCC. Describe the mechanism of action of various therapeutic drugs used in metastatic RCC, including targeted therapies and immunotherapy. Discuss the role of cytoreductive nephrectomy and metastasectomy in metastatic RCC. Review the imaging criteria for evaluating treatment response in metastatic RCC, following systemic therapies.

Key Anatomic/Physiologic Issues and Imaging Findings/Techniques
In this educational exhibit, we will review the role of imaging in the management of metastatic RCC. Role of advanced imaging techniques including Perfusion CT, Perfusion MR, Diffusion weighted MRI, Blood Oxygen Level–Dependent MR, Arterial Spin Labelling and PET CT will be discussed. Tumor response evaluation using RECICT criteria, Choi criteria, Modified Choi criteria, Size and Attenuation CT (SACT) Criteria, Morphology, Attenuation, Size and Structure (MASS) Criteria, Memorial Sloan-Kettering Cancer Center Prognostic Factors, iRECICT criteria will be reviewed

Over 20% of the RCC patients present with metastases at the time of diagnosis and over 50% develop metastases during the course of the disease. Improved understanding of the tumor biology of RCC has led to a paradigm shift in the management of metastatic RCC. Awareness of the molecular cytogenetics of RCC, mechanism of action of the molecular targeted therapies and immunotherapies used in metastatic RCC and recognition of the numerous complications associated with use of these systemic therapies, can help in optimal patient management.