Indian Journal of Nuclear Medicine

INTERESTING IMAGE
Year
: 2022  |  Volume : 37  |  Issue : 1  |  Page : 105--107

Metastatic urinary bladder carcinoma on palliative chemotherapy showing rapid progression on interim fluorodeoxyglucose positron emission tomography/computed tomography


Vivek Kumar Saini, Alen Elias Mammoottil, Aftab Nazar Hassan, Manish Ora, Sanjay Gambhir 
 Department of Nuclear Medicine, SGPGIMS, Lucknow, Uttar Pradesh, India

Correspondence Address:
Dr. Manish Ora
Department of Nuclear Medicine, SGPGIMS, Lucknow - 226 014, Uttar Pradesh
India

Abstract

Bladder cancer (BC) is among the top ten most common cancer types globally. Muscle invasive BC has a high incidence of metastasis. Metastatic BC has a poor prognosis and limited treatment options. Here, we present a middle-aged man with oligometastatic BC, which was treated with palliative chemotherapy. He had significant clinical improvement. However, interim 18F-Fluorodeoxyglucose positron emission tomography/computed tomography demonstrates a rapid disease progression extensive metastasis.



How to cite this article:
Saini VK, Mammoottil AE, Hassan AN, Ora M, Gambhir S. Metastatic urinary bladder carcinoma on palliative chemotherapy showing rapid progression on interim fluorodeoxyglucose positron emission tomography/computed tomography.Indian J Nucl Med 2022;37:105-107


How to cite this URL:
Saini VK, Mammoottil AE, Hassan AN, Ora M, Gambhir S. Metastatic urinary bladder carcinoma on palliative chemotherapy showing rapid progression on interim fluorodeoxyglucose positron emission tomography/computed tomography. Indian J Nucl Med [serial online] 2022 [cited 2022 Jun 26 ];37:105-107
Available from: https://www.ijnm.in/text.asp?2022/37/1/105/340883


Full Text



A 55-year-old male presented with painless hematuria for two months. He had no associated fever or weight loss. Contrast-enhanced computed tomography of the abdomen and pelvic showed a mass in the UB. A transurethral biopsy confirmed muscle-invasive bladder cancer (MIBC). The pretreatment fluorodeoxyglucose positron emission tomography/computed tomography (FDG PET/CT) revealed aUB mass with nontracer avid sub-centimeter size pelvis lymph node (LN). Because of suspicious metastatic lung nodules, he received four cycles of carboplatin and gemcitabine-based palliative chemotherapy. His chemotherapies were uneventful, and hematuria subsided. The patient was referred for a follow-up interim FDG PET/CT scan to evaluate treatment response. It showed rapid progression of the metastatic disease burden [Figure 1] and [Figure 2].{Figure 1}{Figure 2}

Bladder cancer (BC) is the ninth most common cancer in developed countries with poor prognosis and outcome. It is mainly due to delayed diagnosis and limited treatment possibilities. It arises from the urothelial cell lining.[1] The main risk factor for BC is tobacco smoking.[2] At the time of diagnosis, approximately 75% of these have non-MIBC, with the remaining 25% having MIBCor metastatic disease. Early diagnosis and multimodality therapy could result in optimal outcomes. However, metastatic disease is generally incurable, with a dismal 5-year overall survival rate of 15%.[3] Tumors in the advanced T category and atypical histologic features metastasize earlier. It commonly metastasis to the LNs, bones, lungs, liver, and peritoneum.[4]

The metastatic disease had limited treatment options for decades. Cisplatin-based chemotherapy remained a mainstay of treatment. However, with recent advancements, various new therapeutic agents are available. The use of immune checkpoint inhibitors (ICIs) directed at programmed cell-death protein 1 has led to unprecedented survival advantages in selected patients. Atezolizumab and pembrolizumab (both ICIs) may be given in platinum-ineligible advanced UC patients. Recently erdafitinib, a pan-FGFR inhibitor, is approved for advanced metastatic UC.[5]

FDG/PET is increasingly used in the initial metastatic workup and treatment response evaluation. The pooled sensitivity and specificity of FDG PET/CT for staging or restaging are 82% and 89%, respectively.[6] It is found more accurate than CT in the presurgery stage. Following neoadjuvant chemotherapy in MIBC, FDG-PET/CT demonstrated 75% sensitivity and 90% specificity in identifying a complete pathological response.[7] To access the response of first-line systemic chemotherapy (cisplatin and gemcitabine), FDG PET/CT outperformed CT interpretation alone based on Response Criteria in Solid Tumors RECIST criteria.[8] FDGPET/CT predicts progression-free survival and overall survival after two cycles of palliative chemotherapy in metastatic BC.[9] FDG PET/CT helps to detect recurrence and change in treatment decisions in approximately 40% of the patients.[10] Rapid asymptomatic progression of the metastatic BC is uncommon and needs to be reported. This case highlights the value of interim PET-CT to evaluate the treatment response in metastatic BC.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient (s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

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