Renal carcinoma: clinical aspects and therapy

The role of imaging in staging renal adenocarcinoma

Numerous surgical options are available to physicians treating patients with renal adenocarcinoma. In the current clinical setting, imaging plays a key role in determining which options are selected. Newer imaging techniques such as helical CT with CT angiography, MRI, and ultrasound (US) have improved staging capabilities in this patient population. However, to approach staging accuracies recently reported, attention must be paid to proper imaging parameters. This article describes the strengths, limitations, and proper techniques used for staging renal adenocarcinoma with CT, MRI, and US.

Tumor localization and therapeutic potential of an antitumor-anti-CD3 heteroconjugate antibody in human renal cell carcinoma xenograft models

A heteroconjugate (HC) antibody, constructed with the monoclonal antibody (MoAB) Dal K29 to human renal cell carcinoma (RCC) and an anti-CD3 MoAb, could induce a very high level of lysis of human RCC cells when incubated with human peripheral blood lymphocytes (PBL) in vitro (Kerr et al., 1990, J. Immunol., 144, 4060-4067). We now report that this HC antibody selectively localizes in RCC xenografts in nude mice and could inhibit RCC in an ascites tumor xenograft model when administered intraperitoneally together with PBL.

Tumor localization of monoclonal antibodies against human renal carcinoma in a xenograft model

We investigated the localization of intravenously injected DAL K45 and DAL K29, two monoclonal antibodies (MABs) against human renal cell carcinoma (RCC), and their F(ab)2 fragments in nude mice bearing intrarenal transplants of the RCC line Caki-1. More of the MABs or their F(ab)2s specifically localized in the tumor than in any normal tissue with the exception of blood. Compared to parent MABs, F(ab)2s were cleared faster from all tissues. In serum, the MABs and F(ab)2s showed a single radioactive peak retaining partial immunoreactivity. DAL K45-F(ab)2 showed the highest tumor:normal tissue localization ratios and the most distinct gamma-camera image at 24 h.

Inhibition of human renal cancer by monoclonal antibody targeted methotrexate-containing liposomes in an ascites tumor model

The monoclonal antibody DAL K29 against a human renal cell carcinoma associated cell surface antigen was covalently linked to small unilamellar lipid vesicles (SUV) containing the antifolate, methotrexate (MTX), with full retention of antibody activity. In an ascites tumor model developed after intraperitoneal inoculation of 5 x 10(6) cells of the human kidney cancer line Caki-1 per pristane primed nude mouse, the DAL K29 linked MTX-containing SUV was a more potent tumor inhibitor (P less than 0.0005) than the drug or MAB alone, MTX-containing SUV, a mixture of DAL K29 and MTX-containing SUV or MTX-containing SUV linked to an isotype matched nontumor specific IgG.

Inhibition of human renal cancer by monoclonal-anti-body-linked methotrexate in an ascites tumor model

The monoclonal antibody DAL K29 against a cell-surface antigen associated with a human renal cell carcinoma was covalently linked to the antifolate methotrexate with full retention of antibody activity and partial retention of drug activity. Using an ascites tumor model, developed after intraperitoneal (i.p.) inoculation of 5 x 10(6) cells of the human kidney cancer line Caki-1 per pristane-primed nude mouse, we showed that the methotrexate-Dal-K29 conjugate was a more potent tumor inhibitor (P less than 0.0005) of human renal cell carcinoma (which is resistant to currently available modalities including chemotherapy) than the drug or mAb alone, the drug linked to an isotype-matched nontumor-specific IgG or a mixture of the drug and the mAb. Only the conjugate could produce tumor-free survival in a proportion of the mice during the period of observation (i.e. 150 days after tumor inoculation).

Renal masses in adults. Differentiating benign from neoplastic causes

Diagnostic evaluation of renal masses in adults has been a perplexing problem. With the advent of new imaging methods over the past 15 to 20 years, the best approach has varied from institution to institution, depending on the equipment available and the preference of the physician. A diagnostic algorithm is presented here to guide the physician in determining the order in which certain techniques should be considered, thus avoiding unnecessary tests and cutting healthcare costs. In general, benign masses, malignant masses, and pseudoneoplasms have characteristic features that distinguish them from each other if the physician knows how to use the various imaging techniques and interpret results.