FDG-PET/CT in Monitoring Response of Pelvic Lymph Node Metastases to Neoadjuvant Chemotherapy in Bladder Cancer
Mertens LS, Fioole-Bruining A, van Rhijn BW, Kerst JM, Bergman AM, Vogel WV, Vegt E, Horenblas S. J Urol. 2012 Nov 6. pii: S0022-5347(12)05474-2. doi: 10.1016/j.juro.2012.11.009. [Epub ahead of print]


Department of Urology, The Netherlands Cancer Institute - Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands. Electronic address: l.mertens@nki.nl.



To evaluate F18 fluorodeoxyglucose (FDG) - positron emission tomography / computed tomography (PET/CT) for monitoring response of pelvic lymph node metastases to neoadjuvant chemotherapy (NAC) in bladder cancer. A comparison was made with contrast-enhanced CT (CECT).


Nineteen consecutive patients with lymph node positive bladder cancer who underwent FDG-PET/CT and CECT scanning before and after a median of 4 cycles (range: 2-4) of NAC, between September 2011 and April 2012 were studied. Metabolic response was assessed according to EORTC recommendations, based on change in FDG uptake on FDG-PET/CT. Radiological response was assessed on CECT, according to RECIST 1.1. All patients underwent a pelvic lymph node dissection (PLND). Histopathological evaluation was used as the gold standard for nodal response.


Before NAC, hypermetabolic FDG uptake, matching with the LN metastases, was seen in all 19 patients. Evaluating nodal response with PET/CT was feasible in all patients. According to histopathology, 16 patients were responders, of whom 14 obtained a pathological complete response of the LNs. PET/CT correctly distinguished between responders and non-reponders in 18/19 (94.7%), and CECT in 15/19 patients (78.9%). PET/CT correctly distinguished between complete responders and patients with residual disease in 13/19 patients (68.4%), and CECT in 12/19 patients (63.2%).


Although no definitive conclusions can be drawn from these preliminary data, PET/CT scanning appears feasible in evaluating nodal response to NAC and distinguishing between responders and non-responders.