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- Lyrdal, David, 1965, et al.
(author)
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Evaluation of sorafenib treatment in metastatic renal cell carcinoma with 2-fluoro-2-deoxyglucose positron emission tomography and computed tomography.
- 2009
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In: Nuclear medicine communications. - 1473-5628. ; 30:7, s. 519-24
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Journal article (peer-reviewed)abstract
- OBJECTIVE: New potent tyrosine kinase inhibitors such as sorafenib are the most effective treatment for metastatic renal cell carcinoma (MRCC) today. In this study, we used [18F]-2-fluoro-2-deoxyglucose (FDG) with positron emission tomography (PET) combined with computed tomography (CT) to evaluate early effects of sorafenib in patients with MRCC. METHODS: Ten patients, eight males and two females, with a mean age of 61 years (49-72 years), with MRCC were enrolled. A total of 52 lesions, two to nine lesions/patient, out of which 39 were soft lesions, were evaluated. The [18F]FDG-PET/CT was performed before treatment and after 1-2 months. A region of interest (ROI) was identified including the lesions where the glucose uptake was measured, calculating the average value within the ROI and using the cerebellum as the reference. The same ROI was measured in the subsequent FDG-PET. The sum of the diameters was measured in CT according to the Response Evaluation Criteria in Solid Tumors (RECIST). Sorafenib was given 400 mg twice daily orally. RESULTS: After 1-2 months, the mean glucose uptake in all lesions decreased to 75% (32-105%) of initial values of ROI as measured by FDG-PET. The mean glucose uptake in soft lesions decreased to 71% (32-108%) and in skeletal lesions to 82% (53-101%). The sum of the diameters measured by CT decreased to 80% (57-94%) of the initial value in soft lesions according to the RECIST. CONCLUSION: An early decrease in the mean glucose uptake was found in both soft and skeletal lesions after treatment with sorafenib. FDG-PET thus seems to be advantageous, compared with RECIST evaluation, which is limited to soft lesions.
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- Lyrdal, David, 1965, et al.
(author)
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Kidney cancer in Sweden: A decrease in incidence and tumour stage, 1979 - 2001.
- 2013
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In: Scandinavian journal of urology. - : Informa UK Limited. - 2168-1813 .- 2168-1805. ; 47:4, s. 302-310
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Journal article (peer-reviewed)abstract
- Abstract Objective. In the Western world the incidence of renal cell carcinoma (RCC) has been increasing for several decades. In Sweden the incidence has decreased since 1980. This may reflect better health of the population. Another possible explanation could be a decrease in incidentally diagnosed RCC. Since these tumours are smaller, relatively more advanced tumours would then enter the cancer registry. The aim of this study was to compare methods of detection of RCC, tumour characteristics and survival from three periods over a timespan of more than 20 years. Material and methods. Adult patients (n = 515) with RCC were identified in a well-defined population-based area with the same incidence of RCC as the rest of Sweden. Patient data from three periods, 1979 - 1981 (A), 1989 - 1991 (B) and 1999 - 2001 (C), were collected for gender, age, tumour side, method of detection, tumour size, tumour type, metastasis, T stage and Fuhrman grade at the time of diagnosis. Using the Swedish Cause-of-Death Register, cause-specific survival was calculated. When available, tissue was reanalysed according to modern standards by an experienced pathologist. Results.The frequency of ultrasound and computed tomography increased and autopsy and intravenous pyelography decreased with time as the first detection method. There was a significant change towards smaller tumours and less severe stages and grades in more recent periods. Metastatic disease was most common in the first period. The distribution between the different histological tumour types did not change over time. Five-year cause-specific survival increased significantly from 41% to 63%. Subgroup analysis found significantly increased survival for patients with no metastases or with low-grade tumours. Conclusion. The data support a true decrease in the incidence of RCC over time in Sweden with a migration towards lower tumour stages but no change in distribution between the different histological subtypes over time.
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- Lyrdal, David, 1965
(author)
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Localised and Metastatic Renal Cell Carcinoma. Aspects of Treatment.
- 2010
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Doctoral thesis (other academic/artistic)abstract
- Localised and Metastatic Renal Cell Carcinoma. Aspects of Treatment. Aims: Paper I To assess the long-term results in patients operated with NSS in situ for RCC, with special reference to their dependence on tumour grade and stage. Paper II To investigate 18-FDG-PET/CT as an option to assess treatment effects in patients with MRCC treated with targeted therapy, as sorafenib. Paper III To assess optimal dose, efficacy and the tolerability for long-term treatment, when treating MRCC patients with Peg-interferon alfa-2b. Paper IV To disclose imaging characteristics, predictive factors for local recurrence and repeated treatment in small renal masses treated with RFA. Patients and methods: Paper I Records of 87 patients subjected to NSS performed between 1980 and 1999 were reviewed, survival rate was determined with reference to grade stage and multiplicity of renal cell carcinoma (RCC). Paper II Fifty-two lesions (39 soft and 13 bone lesions) in ten patients with MRCC, were evaluated. The 18-FDG-PET/CT was performed prior to treatment (sorafenib (Nexavar® Bayer HealthCare Ltd) 400mg twice daily) and 1–2 months after treatment start-up. The soft lesions were also measured and analysed according to Response Evaluation Criteria in Solid Tumors (RECIST) on CT images. Paper III Twenty-eight patients with MRCC were treated with Peginterferon (Pegintron® Schering- Plough) in escalating doses of 0.5 μg/kg subcutaneously (s.c) weekly until 2 μg/kg was reached or prohibited toxicity occurred. Lesions were evaluated according to RECIST and toxicity according to National Cancer Institute’s common toxicity criteria (NCI-CTC). Paper IV Forty-six tumours in 43 patients were consecutively assessed for possible predictive factors after RFA treatment. At follow-up with CT or magnetic resonance imaging (MRI) possible predictive factors were analysed. Results and conclusion: Paper I Cancer-specific survival in M0 patients, regardless of stage and grade was 80% and 75% at 5 and 10 years, respectively. Stage and grade had a significant impact on long-term survival. The technique can be recommended in imperative indication and in selected cases with patients with normal contra-lateral kidney. Paper II The mean glucose uptake in soft lesions decreased to 71% (32-108%) and to 82% (53-101%) in bone lesions of initial value measured by FDG-PET. Evaluated with RECIST the soft lesions diameter decreased to 80% (57-94%) of initial value. FDG-PET appears to be valuable for evaluation as it is possible to assess both soft and skeletal lesions. Paper III The maximum dose of Peginterferon 2 μg/kg was reached by 46% (n=13) of the patients. Mean dose during long-term treatment was 1.5μg/kg. Median survival in all patients was 19.5 months. Partial response (PR) was seen in 4/11 patients with only intrathoracic lesions. Most side effects were grade 1-2/4, only two patients stopped the treatment due to toxicity. Paper IV Thirty-eight (83%) tumours were completely ablated after the first treatment and 42 (91%) after repeated treatment. Nine patients (21%) showed local recurrence on follow-up, six of those were reablated, mean time to recurrence was 24 months. Maximum tumour diameter and volume were significantly larger and mean necrosis index lower in tumours with incomplete ablation compared to those completely ablated initially. Ultrasound-guided percutaneous RFA is a feasible and repeatable minimal invasive technique under development, for treatment of small renal tumours in selected patients. Keywords: renal cell carcinoma; nephron-sparing surgery; [18F]-2-flouro-2-deoxyglucose; positron emission tomography; metastatic renal cell carcinoma, Peg-interferon alfa-2b; radiofrequency; ablation; percutaneous; ultrasound ISBN: 978-91-628-7968-6
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- Lyrdal, David, 1965, et al.
(author)
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Metastatic renal cell carcinoma treated with Peg-interferon alfa-2b.
- 2009
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In: Acta oncologica (Stockholm, Sweden). - : Informa UK Limited. - 1651-226X .- 0284-186X. ; 48:6, s. 901-8
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Journal article (peer-reviewed)abstract
- INTRODUCTION: Peginterferon has an increased plasma half-life and enables a constant exposure to interferon. This modification might increase the antiangiogenic effect of the treatment and influence the efficacy. We report the results of a phase II open-label study with Peginterferon alfa-2b (Pegintron Schering-Plough) on efficacy and tolerability in patients with advanced renal cell carcinoma (MRCC). MATERIALS AND METHODS: Twenty eight patients with MRCC were treated with Peginterferon in escalating doses of 0.5 microg/kg once weekly until 2 microg/kg was reached or prohibited toxicity occurred. Lesions were evaluated according to Response Evaluation Criteria in Solid Tumors (RECIST). RESULTS: Thirteen patients tolerated a dose of 2 microg/kg/week. At 6 months 16 patients (57%) had disease control of which four had partial response (PR) and 12 stable disease whereas 12 (43%) had progressed. PR was only seen in the lung parenchyma or mediastinum. Median time to progression (TTP) was 8 months in all patients and 13 months for PR and SD patients. Correspondingly, median survival was 19.5 months and 28 months, respectively (seven patients received second-line treatment with tyrosine kinase inhibitor). The mean dose during long-term treatment was 1.5 and at the end of treatment 1.2 microg/kg/week. Most side effects were grade 1-2 and only two patients stopped treatment for that reason. VEGF levels in serum before and during treatment did not correlate to the therapeutic response. DISCUSSION: Peginterferon was well tolerated in MRCC albeit with dose modification during long-term treatment. Response pattern seems to be the same as with nonpegylated interferon. Peginterferon may be used as monotherapy in selected patients and in trials of combinations with targeted drugs.
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- Lyrdal, David, 1965, et al.
(author)
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Ultrasound-guided percutaneous radiofrequency ablation of small renal tumors: Clinical results and radiological evolution during follow-up
- 2010
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In: Acta Radiologica. - : SAGE Publications. - 0284-1851 .- 1600-0455. ; 51:7, s. 808-818
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Journal article (peer-reviewed)abstract
- Background: Treatment of small renal masses with percutaneous radiofrequency ablation (RFA) is under development. Data are limited regarding the oncologic efficacy and complication rates of ultrasound (US)-guided RFA. Purpose: To retrospectively analyze results and factors predictive of incomplete ablation and local recurrence in patients treated for small renal tumors with US-guided percutaneous RFA. Material and Methods: Forty-one consecutive patients (27 males), mean 70 (40–86) years, with 44 tumors were included. Core biopsies were obtained before treatment. Follow-up was performed with CT or MRI. Tumor diameter, tumor volume, volume of the ablation zone, necrosis index, tumor location, distance from tumor to skin, and BMI were analyzed. Results: Biopsies showed malignancy in 72%, 10% were benign, and 18% were inconclusive. Thirty-six tumors (82%) were completely ablated after first RFA and 40 tumors (91%) after a second treatment. Mean follow-up was 27 months. Nine completely ablated tumors (23%) showed local recurrence during follow-up, six of them were retreated. Tumor size was significantly larger and mean necrosis index lower in tumors with incomplete ablation compared with those completely ablated initially. In tumors <30 mm, the initial complete ablation rate was 93% and the local recurrence rate during follow-up was 16% (4/25). Conclusion: US guidance is feasible for RFA of small renal tumors. However, thorough long-term follow-up appears mandatory, as a substantial proportion of the patients will develop late local recurrence and will need more than one RFA treatment session. Large tumor diameter and volume and a low necrosis index were predictive indicators of incomplete ablation after the first treatment.
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