Evaluation of response to gemcitabine plus cisplatin-based chemotherapy using positron emission computed tomography for metastatic bladder cancer

Abstract

Background: The purpose of the present study was to examine retrospectively the contribution of ¹⁸Fluorodeoxyglucose positron emission tomography computed tomography (¹⁸FDG-PET/CT) to the evaluation of response to first-line gemcitabine plus cisplatin-based chemotherapy in patients with metastatic bladder cancer.

Aim: To evaluate the response to Gemcitabine plus Cisplatin -based chemotherapy using ¹⁸FDG-PET/CT imaging in patients with metastatic bladder cancer.

Methods: Between July 2007 and April 2019, 79 patients underwent ¹⁸FDG-PET/CT imaging with the diagnosis of Metastatic Bladder Carcinoma (M-BCa). A total of 42 patients (38 male, 4 female) were included in the study, and all had been administered Gemcitabine plus Cisplatin-based chemotherapy. After completion of the therapy, the patients underwent a repeat ¹⁸FDG-PET/CT scan and the results were compared with the PET/CT findings before chemotherapy according to European Organisation for the Research and treatment of cancer criteria. Mean age was 66.1 years and standard deviation was 10.7 years (range: 41-84 years).

Results: Of the patients, seven (16.6%) were in complete remission, 17 (40.5%) were in partial remission, six (14.3%) had a stable disease, and 12 (28.6%) had a progressive disease. The overall response rate was 57.1 percent.

Conclusion: ¹⁸FDG-PET/CT can be considered as a successful imaging tool in evaluating response to first-line chemotherapy for metastatic bladder cancer. Anatomical and functional data obtained from PET/CT scans may be useful in the planning of secondline and thirdline chemotherapy.

Keywords: 18FDG-PET/CT; Metastatic bladder cancer; Positron emission tomography computed tomography; Response to chemotheraphy.

Figure 1

Distribution of metastatic foci and mean SUV_max. SUV: Standardised uptake value.

Figure 2

Rate of response to chemotheraphy.

Figure 3

Illustrates the metabolic relationship between F-2-fluoro-2-deoxyglucose and cancer cells. D-glucose: The d-isomer of Glucose is d-glucose; Gluc-GP: Glucose- Glycogen phosphorylase (GP); FDG-GP: F-2-fluoro-2-deoxyglucose - Glycogen phosphorylase (GP); FDG: F-2-fluoro-2-deoxyglucose.

Figure 4

Role of molecular imaging in oncology. IGRT: Image-Guided Radiation Therapy.

Figure 5

Shows the relationship between F-2-fluoro-2-deoxyglucose and tumor cells. A: Molecular imaging targets in oncology; B: Relationship between the death of tumor cells – number of viable tumor cells and F-2-fluoro-2-deoxyglucose positron emission tomography. FDG: Fluorodeoxyglucose; FLT1: Fms-related tyrosine kinase 1; FRGD: frgD gene; F Annexin V: ¹⁸F using N-succinimidyl-4-¹⁸F-fluorobenzoic acid; Cu-ATSM: Copper(II)-diacetyl-bis(N(4)-methylthiosemicarbazone.