Staging 18F-fluorodeoxyglucose Positron Emission Tomography/Computed Tomography Changes Treatment Recommendation in Invasive Bladder Cancer

Voskuilen, Charlotte S.; Gennep, Erik J. van; Einerhand, Sarah; Vegt, Erik; Donswijk, Maarten L.; Bruining, Annemarie; Poel, Henk G. van der; Horenblas, Simon; Hendricksen, Kees; Mertens, Laura S.

doi:10.1016/j.euo.2021.01.005

Cited by 34 publications

(27 citation statements)

References 9 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…The highest uptake was obtained by liver metastases (n = 6) and equally by peritoneal carcinomatosis (n = 16) with a mean SUVmax of 9.8. Strong uptakes were also determined in lymph node metastases (n = 36) with a mean SUVmax of 8.7, bone metastases (n = 22) showing a mean SUVmax of 7.8, lung metastases (n = 6) with a mean SUVmax of 5.0, and other metastases (n = 2) with a mean SUVmax of 5.2 (Fig. 1a).…”

Section: Biodistribution and Uptake In Tumor Lesionsmentioning

confidence: 87%

“…68 Ga-FAPI-PET/CT in patients with urinary tract cancer presented a rather strong mean uptake (SUVmax 9.5) as well. For staging purposes, the European Association of Urology guidelines currently recommend contrast-enhanced CT of the chest and abdomen/pelvis [ 21 , 22 ]. However, conventional CT has some limitations due to imprecise determination of the tumor allocation, extent, and invasion.…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

FAP imaging in rare cancer entities—first clinical experience in a broad spectrum of malignancies

Dendl

Finck

Giesel

et al. 2021

Eur J Nucl Med Mol Imaging

View full text Add to dashboard Cite

Purpose 68 Ga-FAPI (fibroblast activation protein inhibitor) is a rapidly evolving and highly promising radiotracer for PET/CT imaging, presenting excellent results in a variety of tumor entities, particularly in epithelial carcinomas. This retrospective analysis sought to evaluate the potential and impact of FAPI-PET/CT in rare cancer diseases with respect to improvement in staging and therapy, based on tracer uptake in normal organs and tumors. Material and methods Fifty-five patients with rare tumor entities, defined by a prevalence of 1 person out of 2000 or less, received a 68 Ga-FAPI-PET/CT scan. Fourteen women and 41 men (median age 60) were included within the following subgroups: cancer of unknown primary (n = 10), head and neck cancer (n = 13), gastrointestinal and biliary-pancreatic cancer (n = 17), urinary tract cancer (n = 4), neuroendocrine cancer (n = 4), and others (n = 7). Tracer uptake was quantified by standardized uptake values SUVmax and SUVmean and the tumor-to-background ratio (TBR) was determined (SUVmax tumor/SUVmean organ). Results In 20 out of 55 patients, the primary tumor was identified and 31 patients presented metastases (n = 88), characterized by a high mean SUVmax in primary (10.1) and metastatic lesions (7.6). The highest uptake was observed in liver metastases (n = 6) with a mean SUVmax of 9.8 and a high TBR of 8.7, closely followed by peritoneal carcinomatosis (n = 16) presenting a mean SUVmax of 9.8 and an excellent TBR of 29.6. In terms of the included subgroups, the highest uptake regarding mean SUVmax was determined in gastrointestinal and biliary-pancreatic cancer with 9.8 followed closely by urinary tract cancer with 9.5 and head and neck cancer (9.1). Conclusion Due to excellent tumor visualization and, thereby, sharp contrasts in terms of high TBRs in primary and metastatic lesions in different rare malignancies, 68 Ga-FAPI-PET/CT crystallizes as a powerful and valuable imaging tool, particularly with respect to epithelial carcinomas, and therefore an enhancement to standard diagnostics imaging methodologies. The realization of further and prospective studies is of large importance to confirm the potential of FAP imaging in oncology.

show abstract

Section: Biodistribution and Uptake In Tumor Lesionsmentioning

confidence: 87%

Section: Discussionmentioning

confidence: 99%

FAP imaging in rare cancer entities—first clinical experience in a broad spectrum of malignancies

Dendl

Finck

Giesel

et al. 2021

Eur J Nucl Med Mol Imaging

View full text Add to dashboard Cite

show abstract

“…68 Ga-FAPI PET/CT in patients with urinary tract cancer, presented a rather strong mean uptake (SUVmax 9.5) as well. For staging purpose, the European Association of Urology guidelines currently recommends contrast-enhanced CT of the chest and abdomen/pelvis (19,20). However, conventional CT has some limitations due to imprecise determination of the tumor allocation, extent and invasion.…”

Section: Discussionmentioning

confidence: 99%

FAP-Imaging in Rare Cancer Entities - First Clinical Experience in a Broad Spectrum of Malignancies

Dendl

Finck

Giesel

et al. 2021

Preprint

View full text Add to dashboard Cite

Purpose: 68Ga-FAPI (fibroblast activation protein inhibitor) is a rapidly evolving and highly promising radiotracer for PET/CT imaging, presenting excellent results in a variety of tumor entities, particularly in epithelial carcinomas. This retrospective analysis sought to evaluate the potential and impact of FAPI-PET/CT in rare cancer diseases with respect to improvement in staging and therapy, based on tracer uptake in normal organs and tumors.Material and Methods: 55 patients with rare tumor entities, defined by a prevalence of 1 person out of 2000 or less, received a 68Ga-FAPI-PET/CT scan. 14 women and 41 men (median age 60) were included within the following subgroups: cancer of unknown primary (n=10), head-and-neck-cancer (n=13), gastro-intestinal and biliary-pancreatic cancer (n=17), urinary tract cancer (n=4), neuroendocrine cancer (n=4) and others (n=7). Tracer uptake was quantified by standardized uptake values SUVmax and SUVmean and the tumor-to-background ratio (TBR) was determined (SUVmax tumor/ SUVmean organ). Results: In 20 out of 55 patients the primary tumor was identified and 31 patients presented metastases (n=88), characterized by a high mean SUVmax in primary (10.1) and metastatic lesions (7.6). Highest uptake was observed by liver metastases (n=6) with a mean SUVmax of 9.8 and a high TBR of 8.7, closely followed by peritoneal carcinomatosis (n=16) presenting a mean SUVmax of 9.8 and an excellent TBR of 29.6. In terms of the included subgroups the highest uptake regarding mean SUVmax was determined in gastro-intestinal and biliary-pancreatic cancer with 9.8 followed closely by urinary tract cancer with 9.5 and head-and-neck cancer (9.1). Conclusion Due to excellent tumor visualization and, thereby, sharp contrasts in terms of high TBRs in primary and metastatic lesions in different rare malignancies, 68Ga-FAPI-PET/CT crystallizes as a powerful and valuable imaging tool, particularly with respect to epithelial carcinomas, and therefore an enhancement to standard diagnostics imaging methodologies. The realization of further and prospective studies is of large importance to confirm the potential of FAP-imaging in oncology.

show abstract

“…A 18 F-FDG-PET/CT is performed for staging purposes prior to NAC, given the incremental value of metabolic information over morphological CT, for assessing lymph node and distant metastases at diagnosis of MIBC [32,33]. In a recent study, it was reported that a staging 18 F-FDG-PET/CT after a conventional diagnostic CT thorax and abdomen changed treatment recommendations in 18% of cases, 9% of which changed from potential curative treatment to palliative treatment due to detection of distant metastases [34]. However, the superiority of 18 F-FDG-PET/CT over conventional CT scanning for clinical response evaluation during NAC has not yet been proven.…”

Section: Pre-operative Stagingmentioning

confidence: 99%

Prediction of pathological response following neoadjuvant chemotherapy in patients with muscle-invasive bladder cancer: the PRE-PREVENCYS trial

et al. 2021

View full text Add to dashboard Cite

Background The recommended treatment for patients with non-metastatic muscle-invasive bladder cancer (MIBC) is neoadjuvant chemotherapy (NAC) and radical cystectomy (RC). Following NAC, 20–40% of patients experience a complete pathological response (pCR) in the RC specimen and these patients have excellent long-term overall survival. Subject to debate is, however, whether patients with a pCR to NAC benefit from RC, which is a major surgical procedure with substantial morbidity, and if these patients might be candidates for close surveillance instead. However, currently it is not possible to accurately identify patients with a pCR to NAC in whom RC might be withheld. The objective of this study is to assess whether pathological response in the RC specimen after NAC can be predicted based on clinical, radiological, and histological variables and on a wide set of molecular biomarkers assessed in tissue, blood and urine. Methods This is a multicentre, prospective cohort study, including patients with cT2a-T4a N0-N1 M0 urothelial cell MIBC who are scheduled to undergo cisplatin-based NAC followed by RC. Prior to start of therapy, a 2-Deoxy-2-[18F] fluorodeoxyglucose (18F-FDG) positron emission tomography/computed tomography (PET/CT) is performed. Response to NAC is evaluated by CT-scan. Blood and urine, including cytology, are prospectively collected for biomarker analyses before and after NAC. Immediately before RC, participants undergo cystoscopy with bimanual examination and a re-staging transurethral resection (TUR) of all visible cancerous lesions or with biopsies from scar tissue. Subsequently, RC is performed in all patients. Tissue from the diagnostic TUR, the re-staging TUR, and the RC specimen is examined for the presence of urothelial cancer carcinoma and DNA and RNA is isolated for molecular analysis. The primary endpoint is the pathological stage (ypTN) in the RC and ePLND specimen and its association with clinical response. Discussion If the PRE-PREVENCYS trial shows that the absence of residual disease after NAC in patients with MIBC is accurately predicted, a randomized controlled trial is scheduled comparing the overall survival of NAC plus RC versus NAC followed by close surveillance for patients with a clinically complete response (PREVENCYS trial). Trial registration Netherlands Trial Register: NL8678; Registered 20 May 2020 https://www.trialregister.nl/trial/8678

show abstract

Staging 18F-fluorodeoxyglucose Positron Emission Tomography/Computed Tomography Changes Treatment Recommendation in Invasive Bladder Cancer

Cited by 34 publications

References 9 publications

FAP imaging in rare cancer entities—first clinical experience in a broad spectrum of malignancies

FAP imaging in rare cancer entities—first clinical experience in a broad spectrum of malignancies

FAP-Imaging in Rare Cancer Entities - First Clinical Experience in a Broad Spectrum of Malignancies

Prediction of pathological response following neoadjuvant chemotherapy in patients with muscle-invasive bladder cancer: the PRE-PREVENCYS trial

Contact Info

Product

Resources

About