Role of PET/CT in muscle-invasive bladder cancer

The purpose of this study covered the diagnostic accuracy and usefulness of positron emission tomography/computed tomography (PET/CT) imaging in muscle invasive bladder cancer patients through previously published literature. Through 30 September, 2019, the PubMed database was searched for eligible articles that evaluated PET/CT imaging in bladder cancer patients. In general, FDG PET/CT, the most commonly used PET/CT imaging, does not show good performance for the detection of primary lesions; however, according to the literature it could accurately assess pelvic lymph node (LN) status better than other imaging technologies and it was especially helpful in determining extra-pelvic recurrences. More recently, non-FDG PET/CT imaging, such as C-11 acetate and C-11 choline, has been introduced. Although further research is required, preliminary results show the potential of these techniques to overcome the drawbacks of FDG. This concise study will overview the role of PET/CT when treating muscle-invasive bladder cancer (MIBC).     

Current chemotherapy of locally advanced or metastatic bladder tumors

Standard chemotherapy of transitional cell carcinoma of the bladder is actually the combination of cisplatine, methothrexate, vinblastine and doxorubicine (MVAC). Although a high response rate, long term survival are rarely observed. More effective agents without toxicity are necessary. Several agents have demonstrated activity alone or in combinations. Combinations regimens use, paclitaxel, gemcitabine and Gallium nitrate, who prove activity alone or in combination with cisplatine or carboplatine, with a response rate of 40 to 70% in patient with visceral localisations. The optimal regimen is not yet determined.     

对局部晚期结直肠癌患者行联合脏器切除术的临床价值

目的探讨对局部晚期结直肠癌患者行联合受累脏器整块切除的临床价值。方法回顾分析182例局部晚期结直肠癌患者的临床资料。将97例行联合脏器切除治疗患者的疗效与同期85例未行联合脏器切除治疗者进行对比分析。结果97例患者切除的相关脏器为165个,经病理组织学证实51例(52.6%)的50个相关脏器(30.3%)有癌浸润,另外46例(47.4%)的115个(69.7%)相关脏器为炎性浸润,受累脏器以小肠最为常见,占28.9%(28/97)。经联合脏器切除后,97例患者1、3、5年生存率分别为83.5%、67.1%和49.4%;而同期85例仅行肿瘤局部切除或姑息切除治疗者1、3、5年生存率分别为81.1%,58.8%和10.5%。结论对于局部晚期的结直肠癌患者,积极施行周围联合脏器切除术,是提高5年生存率的一项重要措施。     

Chemotherapy for advanced bladder cancer: clinical evaluation of chemotherapy for locally advanced or metastatic bladder cancer and adjuvant chemotherapy for deeply invasive bladder cancer following radical cystectomy

Sixteen patients with locally advanced or metastatic bladder cancer were treated with cis-diamminedichloroplatinum (cis-DDP) alone or in combination with other drugs. Eight patients were given cis-DDP intravenously, 6 patients intraarterially and 2 by both methods. Seven patients (44%) showed a partial response, 2 showed a minor response and 4 remained unchanged. Of the 6 patients treated with arterial infusion, 3 achieved a partial response while only 2 of the 8 patients administered intravenously showed a partial response. Eight patients with deeply invasive bladder cancer were treated with cis-DDP alone or in combination with other drugs following radical cystectomy. Cis-DDP was administered every week for 3 courses and every month for 12 courses at a dose of 50 mg and cis-DDP, adriamycin and 5-FU (CAF) were administered at 3 weeks interval for 3 courses and every month for 12 courses. All patients in this group were alive with a median survival of 20 months. One patient had a recurrence 5 months postoperatively. Adjuvant chemotherapy with cis-DDP or their combination was effective. Toxicity was generally tolerable.     

Neoadjuvant and adjuvant chemotherapy in locally advanced bladder cancer

Radical cystectomy has traditionally been considered the gold standard of treatment for patients with muscle-invasive bladder cancer. Following cystectomy a significant portion of patients will develop systemic relapse, usually within 2 to 3 years. Several randomized trials of neoadjuvant and adjuvant chemotherapy suggest that chemotherapy used in combination with primary treatment may improve disease-free survival and permit bladder preservation in selected cases. Whether or not neoadjuvant and adjuvant chemotherapy influence long-term survival remains controversial. This article reviews in depth the various therapeutic options available to patients with locally invasive bladder cancer.     

Concurrent adriamycin and radiotherapy in locally advanced bladder cancer

A prospective 2-phase study was performed on 24 patients with locally advanced transitional cell carcinoma of the urinary bladder to evaluate the toxicity of integrated treatment with Adriamycin 10 mg/m2 (group A) or 20 mg/m2 (group B) and hyperfractionated, accelerated radiotherapy. Local and systemic toxicity with Adriamycin 10 mg/m2 was significantly lower than with 20 mg/m2. Complete tumour remission was achieved in 18 patients (6 of 8 patients in group A and 12 of 16 in group B). In 12 cases the treatment could be stopped after the first series.     

Treatment of muscle-invasive and metastatic bladder cancer: update of the EAU guidelines

Context

New data regarding treatment of muscle-invasive and metastatic bladder cancer (MiM-BC) has emerged and led to an update of the European Association of Urology (EAU) guidelines for MiM-BC.

Objective

To review the new EAU guidelines for MiM-BC with a specific focus on treatment.

Evidence acquisition

New literature published since the last update of the EAU guidelines in 2008 was obtained from Medline, the Cochrane Database of Systematic Reviews, and reference lists in publications and review articles and comprehensively screened by a group of urologists, oncologists, and a radiologist appointed by the EAU Guidelines Office. Previous recommendations based on the older literature on this subject were also taken into account. Levels of evidence (LEs) and grades of recommendations (GRs) were added based on a system modified from the Oxford Centre for Evidence-based Medicine Levels of Evidence.

Evidence synthesis

Current data demonstrate that neoadjuvant chemotherapy in conjunction with radical cystectomy (RC) is recommended in certain constellations of MiM-BC. RC remains the basic treatment of choice in localised invasive disease for both sexes. An attempt has been made to define the extent of surgery under standard conditions in both sexes. An orthotopic bladder substitute should be offered to both male and female patients lacking any contraindications, such as no tumour at the level of urethral dissection. In contrast to neoadjuvant chemotherapy, current advice recommends the use of adjuvant chemotherapy only within clinical trials. Multimodality bladder-preserving treatment in localised disease is currently regarded only as an alternative in selected, well-informed, and compliant patients for whom cystectomy is not considered for medical or personal reasons. In metastatic disease, the first-line treatment for patients fit enough to sustain cisplatin remains cisplatin-containing combination chemotherapy. With the advent of vinflunine, second-line chemotherapy has become available.

Conclusions

In the treatment of localised invasive bladder cancer (BCa), the standard treatment remains radical surgical removal of the bladder within standard limits, including as-yet-unspecified regional lymph nodes. However, the addition of neoadjuvant chemotherapy must be considered for certain specific patient groups. A new drug for second-line chemotherapy (vinflunine) in metastatic disease has been approved and is recommended.     

新辅助化疗后行根治性切除术治疗局部转移性膀胱癌患者的临床研究

目的 考察新辅助化疗后行根治性切除术治疗局部转移性膀胱癌患者的临床疗效.方法 回顾性分析局部转移性膀胱癌患者临床资料37例,依据是否接受新辅助化疗分为观察组(20例)和对照组(17例).观察组患者使用顺铂、吉西他滨新辅助化疗后行根治性切除术治疗.对照组患者接受根治性切除术治疗.随访记录患者化疗效果、前后肿瘤大小、不良反应和生存期.结果 化疗后患者治疗有效率75.0％ (15/20),肿瘤直径显著降低(P＜0.01).不良反应总体发生率为70.0％ (14/20),且主要为Ⅰ～Ⅱ级.观察组患者中位生存期41个月显著高于对照组的26个月(P＜0.05).结论 新辅助化疗可以获得较高应答率,显著缩小肿瘤,结合手术治疗可延长患者生存期.     

Hyperfractionated, accelerated radiotherapy and concurrent chemotherapy in locally advanced bladder cancer

A prospective study was performed on 11 patients with locally advanced transitional cell carcinoma of the bladder to evaluate the toxicity of an integrated treatment with cis-platinum (70 mg/m2 body surface), doxorubicin (10 mg/m2 body surface) and 8 meV photons. Local and systemic toxicity caused by this treatment schedule was minor. Late sequelae consisted of reduced bladder capacity in 2 patients and proctitis in 1 patient. Complete clinical clearance of the local tumor could be achieved in 9 of 11 patients after a mean follow-up of 8.1 months.     

局部晚期和远处转移胰腺癌的姑息治疗

More than 25％ pancreatic cancers are locally advanced and unresectable.For patients underwent pancreatectomy,about 80％ of patients had pancreatic cancer recurrence in 2 years.The aim of palliative treatment for locally advanced and metastatic pancreatic cancer is to relieve the disease-associated symptoms,including biliary obstruction,duodenal obstruction,and intractable abdominal pain.Surgical strategies,such as palliative resection (R1 resection ),biliary drainage and gastroenterostomy have been widely used.During recent years,neoadjuvant chemotherapy and radiation have been recommended as the palliative treatment of choice for patients with locally advanced and metastatic pancreatic cancer.However,The controversy still exists.This article summarized current data of surgical and non-surgical strategies for the treatment of locally advanced and metastatic pancreatic cancer.     

The prognostic value of adjuvant and neoadjuvant chemotherapy in total cystectomy for locally advanced bladder cancer

PURPOSE: Adjuvant chemotherapy and neoadjuvant chemotherapy have been widely used as adjuvant treatment in patients requiring total cystectomy for locally advanced transitional cell carcinoma of the bladder. However, there has been no conclusive evidence that the adjunctive chemotherapy improves survival and no agreement exists concerning what subsets of such patients receive significant benefits from the adjunctive chemotherapy. The study retrospectively sought to clarify these points. PATIENTS AND METHODS: We retrospectively analyzed clinical and pathological records of the 229 patients with transitional cell carcinoma of the bladder who underwent total cystectomy with or without lymph node dissection in our University Hospital from January 1975 to December 1997. Forty-two patients received 1-4 cycles (mean = 1.7) of adjuvant chemotherapy with VPMisCF (n = 19), CisCA (n = 4), MVAC (n = 8), or MEC (Methotrexate, Epirubicin and Cisplatin) (n = 11). Twenty-three patients received 1-4 cycles (mean = 2.1) of neoadjuvant chemotherapy with CisCA (n = 2), MVAC (n = 5), or MEC (n = 16). Using the Kaplan-Meier method, disease-specific survival rate was assessed according to various clinical and pathological factors as well as the administration of adjuvant or neoadjuvant chemotherapy. The generalized-Wilcoxon test was used to evaluate statistical significance (p < 0.05) of survival curves for two or more groups. In addition, a multivariate analysis using the Cox proportional hazards model was performed with respect to multiple clinical and pathological parameters, and treatment modalities. RESULTS: In patients who received neither adjuvant chemotherapy nor radiotherapy, the disease-specific survival rate was significantly lower in those with pT3a and/or more advanced tumors compared with those with pT2 or less advanced tumors. The survival rate in patients with positive lymph node metastasis was significantly lower than that in patients without lymph node metastasis. No apparent survival benefit was noted for those patients who received adjuvant chemotherapy when compared with patients who had pT3a or more advanced tumor and were followed without any adjunctive therapy. In patients with pN2 or more advanced lymph node metastasis, the survival rate of those who received adjuvant CisCA/MVAC/MEC chemotherapy was significantly higher than that those without any adjunctive therapy. Although no apparent survival benefit was observed in patients who received neoadjuvant chemotherapy, the survival rate in patients whose tumor was considered to be down-staged to pT1 or lower was significantly higher than patients who did not receive neoadjuvant chemotherapy and had pT3a or higher pT-stage tumor. The survival rate in patients whose tumor showed clinical partial or complete response by neoadjuvant chemotherapy was also significantly higher than the same control patients. However, the multivariate analysis revealed no significant survival benefit after adjuvant chemotherapy or after neoadjuvant chemotherapy. CONCLUSIONS: Adjuvant chemotherapy after total cystectomy is an acceptable approach in patients with pN2 or higher pN-stage bladder cancer. The significant survival benefit may be obtained who acquired pathological downstaging or partial to complete clinical response after neoadjuvant chemotherapy. To get maximum survival benefit from the present chemotherapeutic regimens and exclude administration of toxic chemotherapeutic agents to unresponsive patients, there should be more reliable markers that give clear information to differentiate tumors that will respond fairly to present chemotherapeutic regimens from tumors that will respond poorly.     

Concomitant radiotherapy and carboplatin in locally advanced bladder cancer.

OBJECTIVE: The aim of the study was to assess the efficacy and safety of concomitant radiotherapy (CRT) and carboplatin. PATIENTS AND METHODS: From 1992 until 1997, 67 patients with T3 invasive bladder cancer (IBC) were treated using CRT and carboplatin. X-Ray radiotherapy (10 MeV) was applied using LINAC in a locoregional technique, with a total tumor dose of 65 Gy in 32 fractions. Carboplatin was administered as a bolus infusion once a week, on day 5, up to a total dose of 900 mg. RESULTS: The most frequent toxicity was hematological. Of the 67 treated patients, 92.5% achieved a clinically complete response, and 7.5% developed progressive disease during therapy. The 5-year overall survival was 55% and disease-free survival was 35%. CONCLUSION: CRT and carboplatin appear to be safe and extremely active in the treatment of T3 IBC, but the results should be confirmed in a randomized study.     

Treatment for locally advanced bladder cancer in elderly patients

As the life expectancy of Japanese population has been increasing, how best to treat invasive bladder cancer in elderly patients has become a new problem. Generally standard treatment for locally advanced invasive bladder cancer is thought to be radical cystectomy, but that for elderly patients is still controversial due to frequent presence of comorbid diseases. Here, we debate the merits and demerits of radical cystectomy and bladder preservation for elderly patients with locally advanced invasive bladder cancer. First, we presented the treatment outcome of 1131 patients with invasive bladder cancer who underwent radical cystectomy in Japan, to clarify the characteristics of invasive bladder cancer of elderly patients and to determine whether age had an impact on the clinical or functional results. Furthermore, to clarify the indication of the bladder preservation for elderly patients, we reviewed the results of recent trials. Several new trials of chemoradiotherapy have shown high response rates with low local morbidity but high systemic morbidity requiring dose reductions or treatment delay. This regimen may prove to be effective for inoperable patients and may be proposed as conservative treatment for patients with complete responses to the initial course of chemoradiation. Although chemoradiation shows promise, more trials are needed to clarify the morbidity and mortality rates of chemoradiation for elderly patients.     

Clinical value of whole body fluorine‐18 fluorodeoxyglucose positron emission tomography/computed tomography in the detection of metastatic bladder cancer

Objectives: To investigate the value of whole‐body fluorine‐18 2‐fluoro‐2‐deoxy‐D‐glucose positron emission tomography/computed tomography for the detection of metastatic bladder cancer. Methods: From December 2006 to August 2010, 60 bladder cancer patients (median age 60.5 years old, range 32–96) underwent whole body positron emission tomography/computed tomography positron emission tomography/computed tomography. The diagnostic accuracy was assessed by performing both organ‐based and patient‐based analyses. Identified lesions were further studied by biopsy or clinically followed for at least 6 months. Results: One hundred and thirty‐four suspicious lesions were identified. Among them, 4 primary cancers (2 pancreatic cancers, 1 colonic and 1 nasopharyngeal cancer) were incidentally detected, and the patients could be treated on time. For the remaining 130 lesions, positron emission tomography/computed tomography detected 118 true positive lesions (sensitivity = 95.9%). On the patient‐based analysis, the overall sensitivity and specificity resulted to be 87.1% and 89.7%, respectively. There was no difference of sensitivity and specificity in patients with or without adjuvant treatment in terms of detection of metastatic sites by positron emission tomography/computed tomography. Compared with conventional imaging modality, positron emission tomography/computed tomography correctly changed the management in 15 patients (25.0%). Conclusions: Positron emission tomography/computed tomography has excellent sensitivity and specificity in the detection of metastatic bladder cancer and it provides additional diagnostic information compared to standard imaging techniques.     

Prognostic value of modified Glasgow Prognostic Score in non–muscle-invasive bladder cancer

Purpose

To investigate the prognostic value of preoperative modified Glasgow Prognostic Score (mGPS) in patients with non–muscle-invasive bladder cancer (NMIBC) treated with transurethral resection of bladder with or without intravesical therapy.

Concurrent platinum-based chemotherapy and radiotherapy for locally advanced bladder cancer

Eight patients with locally advanced bladder cancer who were not candidates for radical cystectomy or concurrent intra-arterial chemotherapy and radiotherapy were treated with combined platinum-based chemotherapy and radiation therapy. Six of the eight patients (75%) achieved a clinical complete response (CR). The effect of therapy in four patients whose histopathological responses were evaluated was effect grade 3. One of the eight patients died of treatment-related myelosuppression. The other two patients died of intercurrent disease, while the remaining five patients are alive with preservation of a functional bladder. The 2-year overall survival rate was 87.5%. Adverse events due to chemotherapy were mainly bone marrow suppression. Those caused by radiation therapy were rectal irritability. We considered concurrent platinum-based chemotherapy and radiotherapy useful for the treatment of locally advanced bladder cancer.     

18F-FDG PET/CT显像在肾癌中的临床应用价值

目的:评价18F-脱氧葡萄糖(18F-fluorodeoxyglucose,18F-FDG)正电子发射计算机断层扫描(PET)/CT显像对肾癌诊断和治疗方案选择的临床应用价值.方法:回顾性分析56例临床诊断为肾癌患者的全身18F-FDG PET/CT和CT平扫加增强扫描的影像学资料.比较两者对肾癌的诊断价值.结果:56例患者中,经手术病理检查实为肾癌者47例.其余9例因18F-FDG PET/CT显像发现有转移病灶者放弃手术.18F-FDG;PET/CT 榆古敏感度为80.4%;CT平扫加增强扫描的敏感度为92.9%.9例转移病例中,3例为腹膜后淋巴结转移,3例两肺多发转移,2例骨转移并肝转移,1例伴有下腔静脉和肾静脉癌栓形成,而CT平扫加增强扫描仅发现1例肾静脉和下腔静脉痛栓形成.结论:18F-FDG PET/CT显像对诊断原发性肾癌的敏感性不如CT,但对淋巴结转移及远处转移的诊断优于CT,对肾癌的分期、治疗方案的选择及预后的判断有重要意义.