Evaluation of response to gemcitabine plus cisplatin-based chemotherapy using positron emission computed tomography for metastatic bladder cancer

Table 1 Characteristics of patients and disease

Characteristics	No. %
Gender
Male	38 (90.4)
Female	4 (9.6)
Age (yr)
Median	66.1
Range	41-84
Primary site	4 (9.6)
Bladder	38 (90.4)
Bladder, ureter, renal pelvis	4 (9.6)
Site of metastasis
Lymph node	65 (53.2)
Bone	30 (24.6)
Lung	26 (21.3)
Liver	10 (8.1)
Soft tissue	10 (8.1)
Other1	3 (2.4)

¹Adrenal gland, penile.

Table 2 Response criteria as defined by response evaluation criteria in solid tumors, world health organization, and the research and treatment of cancer

	RECIST	WHO	EORTC
Complete remission	Disappearance of all disease	Disappearance of all disease	Complete resolution of FDG uptake within the tumor volume
Partial remission	Decrease ≥ 30% in the sum of the greatest dimension of all measurable disease	Decrease ≥ 50% in the sum of the cross products	A reduction of a minimum of 15%-25% in tumor FDG SUV after one cycle of chemotherapy, and greater than 25% after more than one treatment cycle
Stable disease	Decrease < 30% and increase < 20% in the sum of the greatest tumor dimensions	Decrease < 50% and increase < 20% in the sum of the cross products	Increase of less than 25% or a decrease of less than 15% in tumor FDG SUV and no visible increase in extent (20% in the longest dimension)
Progressive disease	Increase ≥ 20% in the sum of the greatest tumor dimensions	Increase ≥ 50% in the sum of the cross products	Increase in FDG tumor SUV of greater than 25% within the tumor region, or increase of extend of FDG uptake (20% in the longest direction) or appearance of new lesions

RECIST: Response evaluation criteria in solid tumors; WHO: World health organization; EORTC: Research and treatment of cancer; FDG: F-2-fluoro-2-deoxyglucose; SUV: Standardised uptake value.

Table 3 Treatment recommendations in metastatic baldder carcinoma

First line treatment			Second and third line treatments
Patients eligible to cisplatin	Unfit patients	Cisplatin sensitive disease	Cisplatin refractory disease
MVAC, HD-MVAC, GC, and DD-GC	GCa and MCAVI	Cisplatin based doublet not used in first line	Vinflunine, Paclitaxel-gemcitabine, and all actives drugs not used

MVAC: Methotrexate-vinblastine-doxorubicin-cisplatin; HD: High dose; GC: Gemcitabin-cisplatin; DD: Dose dense; MCAVI: Methotrexate-carboplatin-vinblastine; GCa: Gemcitabine plus carboplatin;

Table 4 Diagnostic performance of ¹⁸Fluorodeoxyglucose positron emission tomography computed tomography studies in the literature

Ref.	Modality	n	Status of the BCa	Sensitivity, %	Specifity, %
Drieskens et al[14]	FDG-PET/CT	55	Metastatic BCa	60	88
Apolo et al[16]	FDG-PET/CT	47	Metastatic BCa	88	87
Liu et al[33]	FDG-PET/CT	55	Metastatic BCa	77	97
Lu et al[15]	FDG-PET/CT	-	Metastatic BCa	89	82

Average values from meta-analysis of 4 individual positron emission tomography/computed tomography studies. BCa: Bladder cancer; FDG-PET/CT: Fluorodeoxyglucose positron emission tomography computed tomography.