Pavlos Msaouel, Associate Professor of Genitourinary Medical Oncology at MD Anderson Cancer Center, shared a post on LinkedIn:
“Pleased to share work published today in the Journal of Nuclear Medicine that is genuinely practice-informing for renal medullary carcinoma (RMC): “Utility of [18F]FDG PET/CT in Evaluating Extent of Disease and Impact on Treatment Management“.
RMC is a rare, highly aggressive kidney cancer of young patients with sickle cell trait with no therapeutic overlap with the common clear cell RCC. Accurate staging therefore can directly determine whether a patient is best served by surgery, definitive/consolidative radiation, or systemic therapy.
In the largest cohort of RMC patients evaluated with metabolic imaging to date (n=49, MD Anderson, 2016–2025), the key findings:
RMC is intensely glucose-avid — 98% of patients (48/49) had clearly FDG-avid disease, with the single PET-negative patient also showing no disease on anatomic imaging. This is a sharp contrast to clear cell RCC, where FDG avidity is variable, and it points to an intrinsic metabolic phenotype.
FDG PET/CT outperformed conventional imaging. In 65% of patients (31/48), PET detected additional metastases — predominantly bone, nodal, and soft tissue — not seen on CT/MRI. Notably, no lesions were found on anatomic imaging that PET missed.
The added sensitivity translated into actionable treatment changes in 21% (10/48) of patients with active disease, thus redirecting several patients to radiation or chemoradiation, and systemic therapy changes in others.
The metabolic signal was robust. Near-perfect interobserver agreement (99.4% lesion detection), and no significant difference in SUVmax between treatment-naïve and previously treated patients (mixed-effects model, P=0.317), suggesting the high avidity is intrinsic and persists despite prior therapy. These data support inclusion of FDG PET/CT in clinical practice.
The usual honest caveats apply: this is a retrospective, single-center study, with scans obtained during routine care (so some variability in timing relative to therapy), and histologic confirmation for only a subset of lesions. Prospective validation is the next step along with developing quantitative PET biomarkers (metabolic tumor volume, total lesion glycolysis) for prognostication and response assessment, potentially alongside circulating markers such as CA-125 we previously described: https://lnkd.in/gg_fFAnN
Congratulations and thanks to our Nuclear Medicine leads, Simone Krebs and Devaki Shilpa Surasi, and to our multidisciplinary collaborators across nuclear medicine, GU medical oncology, urology, radiation oncology, interventional radiology, and pediatrics at MD Anderson. And deepest gratitude to our patients and their families, who entrust us with their care and make this work possible.”
Title: Renal Medullary Carcinoma: Utility of [18F]FDG PET/CT in Evaluating Extent of Disease and Impact on Treatment Management
Authors: Simone Krebs, Ahmed E. Salem, Nghi C. Nguyen, Rahul A. Sheth, Jose A. Karam, Najat C. Daw, Chad Tang, Nizar M. Tannir, Pavlos Msaouel, Devaki Shilpa Surasi
Read the Full Article.
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