Fdg-Positron Emission Tomography For Assessing The Response To Neo-Adjuvant Chemotherapy In Bladder Cancer Patients

You have accessJournal of UrologyBladder Cancer: Epidemiology & Evaluation II1 Apr 2018MP71-09 FDG-POSITRON EMISSION TOMOGRAPHY FOR ASSESSING THE RESPONSE TO NEO-ADJUVANT CHEMOTHERAPY IN BLADDER CANCER PATIENTS Ayman Soubra, Mehmet Gencturk, Jerry Froehlich, Priya Balaji, Shilpa Gupta, Gautam Jha, and Badrinath Konety Ayman SoubraAyman Soubra More articles by this author , Mehmet GencturkMehmet Gencturk More articles by this author , Jerry FroehlichJerry Froehlich More articles by this author , Priya BalajiPriya Balaji More articles by this author , Shilpa GuptaShilpa Gupta More articles by this author , Gautam JhaGautam Jha More articles by this author , and Badrinath KonetyBadrinath Konety More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2018.02.2273AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES To date, there is no consensus recommendation on a restaging evaluation during the course of neo-adjuvant chemotherapy (NAC) to identify patients with chemo-sensitive muscle invasive bladder cancer (MIBC). The interpretation of the anatomic information provided by CT scan or MRI is challenging post NAC because any hemorrhagic inflammation and necrosis can mimic a residual tumor. The objective of this study was to determine the performance characteristics of PET CT as compared to regular CT scans in assessing the response to NAC in patients with bladder cancer scheduled to undergo radical cystectomy. METHODS All patients treated at our center for MIBC are counseled and offered neo-adjuvant chemotherapy (NAC) before radical cystectomy (RC). FDG-PET-CT scans were performed prior to start of chemotherapy, after 2 cycles and after completion of the regimen. Complete responders to NAC were those who had (pT0) or residual carcinoma in-situ (pTis) on final pathology. Those who were down-staged from muscle invasive to non-muscle invasive cancer were considered to have a chemo-sensitive tumor. We used percentage reduction in SUVmax from PET-CT scans as our measure to correlate with the final pathology after cystectomy. RESULTS 37 patients who had muscle invasive bladder cancer and underwent NAC followed by RC were included in the final analysis. FDG-PET-CT had 78.5% sensitivity (95.6% specificity) in identifying complete pathologic responders with a -100% change in SUVmax. Three patients with complete resolution of hypermetabolism of the primary tumor on PET-CT had residual pT1 tumor on pathology. PET-CT had 83% sensitivity ( 94% specificity) for the detection of chemo-sensitive tumors. Only one patient had complete resolution of cancer on imaging but had a small focus of pT2 on final pathology. Two patients had 71.7% and 68% reduction in SUVmax and had pT1 and pTis on final pathology respectively, but did not meet the study criteria to be considered as a chemo-sensitive tumor. CONCLUSIONS FDG-PET-CT can help determine the response of primary tumor to neoadjuvant chemotherapy in patients with muscle invasive bladder cancer and hence can predict more accurately the prognosis of the patients, or potentially the appropriate time for cystectomy and the need to complete the NAC regimen. © 2018FiguresReferencesRelatedDetails Volume 199Issue 4SApril 2018Page: e946 Advertisement Copyright & Permissions© 2018MetricsAuthor Information Ayman Soubra More articles by this author Mehmet Gencturk More articles by this author Jerry Froehlich More articles by this author Priya Balaji More articles by this author Shilpa Gupta More articles by this author Gautam Jha More articles by this author Badrinath Konety More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...