Prospective Evaluation of FDG-PET/CT for On-treatment Assessment of Response to Neoadjuvant or Induction Chemotherapy in Invasive Bladder Cancer.
Bladder cancer
Positron emission tomography (PET)
computed tomography (CT)
fluorodeoxyglucose F18
imaging
lymph-node
metastasis
urothelial carcinoma
Journal
Bladder cancer (Amsterdam, Netherlands)
ISSN: 2352-3735
Titre abrégé: Bladder Cancer
Pays: Netherlands
ID NLM: 101668567
Informations de publication
Date de publication:
2023
2023
Historique:
received:
31
03
2022
accepted:
01
12
2022
medline:
31
3
2023
pubmed:
31
3
2023
entrez:
12
7
2024
Statut:
epublish
Résumé
Neoadjuvant/induction chemotherapy (NAIC) improves survival in patients with muscle-invasive bladder carcinoma (MIBC). On-treatment response assessment may aid in decisions to continue or cease NAIC. We investigated whether We prospectively included 83 patients treated for MIBC (i.e. high-risk cT2-4N0M0 or cT1-4N+M0-1a) between 2014 and 2018. Response to NAIC was assessed after 2-3 cycles with FDG-PET/CT (Peter-Mac and EORTC criteria) and CECT (RECIST1.1 criteria). We assessed prediction of complete pathological response (pCR; ypT0N0), complete pathological down-staging (pCD;≤ypT1N0), any down-staging from baseline (ypTN < cTN) and progression (inoperable tumor/ypN+/M+). The reference standard was histopathological assessment or clinical follow-up. Sensitivity, specificity, and accuracy were calculated. Pathological response rates were 21% for pCR, 29% for pCD, and 10% progressed. All patients underwent FDG-PET/CT and 61 patients also underwent CECT (73%). Accuracy of FDG-PET/CT for prediction of pCR, pCD, and progression were 73%, 48%, and 73%, respectively. Accuracy of CECT for prediction of pCR, pCD, and progression were 78%, 65%, and 67%, respectively. Specificity of CECT was significantly higher than FDG-PET/CT for prediction of pCD and any down-staging ( Routine FDG-PET/CT has insufficient predictive power to aid in response assessment compared to CECT.
Sections du résumé
BACKGROUND
BACKGROUND
Neoadjuvant/induction chemotherapy (NAIC) improves survival in patients with muscle-invasive bladder carcinoma (MIBC). On-treatment response assessment may aid in decisions to continue or cease NAIC.
OBJECTIVE
OBJECTIVE
We investigated whether
METHODS
METHODS
We prospectively included 83 patients treated for MIBC (i.e. high-risk cT2-4N0M0 or cT1-4N+M0-1a) between 2014 and 2018. Response to NAIC was assessed after 2-3 cycles with FDG-PET/CT (Peter-Mac and EORTC criteria) and CECT (RECIST1.1 criteria). We assessed prediction of complete pathological response (pCR; ypT0N0), complete pathological down-staging (pCD;≤ypT1N0), any down-staging from baseline (ypTN < cTN) and progression (inoperable tumor/ypN+/M+). The reference standard was histopathological assessment or clinical follow-up. Sensitivity, specificity, and accuracy were calculated.
RESULTS
RESULTS
Pathological response rates were 21% for pCR, 29% for pCD, and 10% progressed. All patients underwent FDG-PET/CT and 61 patients also underwent CECT (73%). Accuracy of FDG-PET/CT for prediction of pCR, pCD, and progression were 73%, 48%, and 73%, respectively. Accuracy of CECT for prediction of pCR, pCD, and progression were 78%, 65%, and 67%, respectively. Specificity of CECT was significantly higher than FDG-PET/CT for prediction of pCD and any down-staging (
CONCLUSIONS
CONCLUSIONS
Routine FDG-PET/CT has insufficient predictive power to aid in response assessment compared to CECT.
Identifiants
pubmed: 38994487
doi: 10.3233/BLC-220036
pii: BLC220036
pmc: PMC11181845
doi:
Types de publication
Journal Article
Langues
eng
Pagination
49-57Informations de copyright
© 2023 – The authors. Published by IOS Press.
Déclaration de conflit d'intérêts
SMHE: none CSV: none EEFvdP: none MLD: none AB: none MSvdH: No conflicts of interest regarding the data presented in this manuscript. Other disclosures are research support from Bristol-Myers Squibb, AstraZeneca, 4SC and Roche and consultancy fees from Bristol-Myers Squibb, Merck, Merck Sharp & Dohme, Roche, AstraZeneca, Seattle Genetics, Pfizer and Janssen (all paid to the Netherlands Cancer Institute). LSM: none KH: none EV: none BWGvR: is an Editorial Board member of this journal, but was not involved in the peer-review process nor had access to any information regarding its peer-review. No conflicts of interest regarding the data presented in this manuscript. Other disclosures are Advisory Board meetings of QED Therapeutics and Ferring.