March 1, 2007

Contribution Of 11C-Choline Positron Emission Tomography/Computerized Tomography To Preoperative Staging Of Advanced Transitional Cell Carcinoma The SWOG neoadjuvant trial published in the New England Journal of Medicine in 2003 suggested that select patients with locally advanced bladder cancer might benefit from chemotherapy before surgery. Even in the most experienced investigators, however, the question remains: what criteria should we use to select patients for neoadjuvant chemotherapy?

In the September issue of the Journal of Urology, Gofrit and colleagues from the Hadassah-Hebrew University Medical Center present encouraging data suggesting that PET CT may identify patients with metastatic bladder cancer.

A total of 18 patients with 19 transitional cell carcinomas (17 bladder and 2 upper tract) underwent preoperative staging with CT scan of the chest, abdomen, and pelvis showing no evidence of metastatic disease. 11C-choline positron emission tomography with CT was performed in all patients.

11C-choline uptake was seen in all primary tumors, with 6 patients exhibiting uptake of regional lymph nodes as small as 5 mm. Histologic confirmation was obtained in 3 of the 4 patients who underwent surgery. Furthermore, despite an initial negative traditional staging evaluation, metastases to bone were seen in 4 patients using PET CT technology. All metastases were confirmed by additional computerized tomography.

In summary, this small study suggests that PET CT technology may serve as a useful additional tool in the staging of patients with advanced urothelial cancer.

GofritВ ON, MishaniВ E, OreviВ M, KleinВ M, FreedmanВ N, PodeВ D, ShapiroВ A, KatzВ R, LibsonВ E, ChisinВ R
J Urol 176(3): 940-94, 2006.

Reviewed by Contributing Editor Ricardo Sanchez-Ortiz, MD

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