18F-FDG-PET/CT in Potentially Advanced Renal Cell Carcinoma: A Role in Treatment Decisions and Prognosis Estimation

Aim: to assess the influence of positron emission tomography/computed tomography with F-18-fluorodeoxyglucose (F-18-FDG-PET/CT) on the treatment decision in renal cell carcinoma and to assess the prognostic value of the F-18-FDG accumulation assessments. Patients and Methods: Data from 60 patients were included. The cohort consisted of 43 males, 17 females, mean age 66.2 years (range=49-86 years). All patients underwent F-18-FDG-PET/CT including two-phase CT-angiography of the kidneys. Locally advanced or generalized renal cell carcinoma was suspected in all patients. The level of the F-18-FDG accumulation within the tumor was compared with the histological grading and the development of the disease was assessed 12 months after F-18-FDG-PET/CT. Results: Overall mortality reached 46.7%, the highest F-18-FDG accumulation showed tumor of grade 4 (mean SUVmax=10.7, range=5-23), the highest mortality was found for tumors exceeding SUVmax value of 10 (mortality 62.5%). New information was brought by F-18-FDG-PET/CT in 85% of cases. Conclusion: F-18-FDG-PET/CT has the potential to estimate the patient's survival according to the F-18-FDG accumulation measured in SUVmax. Depiction of occult metastatic disease has an emerging role in decision making regarding surgery.