Purpose
Background
Bladder cancer is the fourth most common cancer in men and twelfth most common cancer in women in the UK [1].
The five-year survival rate for muscle-invasive bladder cancer is < 50% [2].
Increasingly,
treatments are being used which include:
- Concurrent chemo-radiotherapy with bladder sparing.
- Neo-adjuvant chemotherapy + surgery or radiotherapy.
The clinical problem
Treatment of bladder cancer with neo-adjuvant chemotherapy affects normal tissues as well as tumours.
This results in normal tissue toxicity.
Some patients experience adverse bowel and bladder effects...
Methods and Materials
Patients
12 patients with primary bladder cancer (9 M,
3 F; age = 45 – 73 yrs,
mean = 60 yrs).
DCE-MRI performed before and after treatment with neo-adjuvant chemotherapy (mean time of scan after completing neo-adjuvant chemotherapy = 34 days,
range = 27 – 44 days).
Early toxicity symptoms were reported by patients.
MR protocol
1.5 T Siemens Magnetom Avanto.
T2-w scans for localisation of suspicious area.
0.1 mmol/kg Gd-DTPA injected intravenously.
3D axial T1-weighted VIBE sequence used for acquisition of dynamic series:
-...
Results
Example images
Fig.
1 shows example images obtained from one patient pre- and post-neo-adjuvant chemotherapy demonstrating the VOIs defined.
Fig.
2 shows the resulting signal-intensity time curves obtained from the rectum VOIs.
The curve obtained before chemotherapy shows a slow increase in signal-intensity while the curve obtained after chemotherapy shows high rapid increase.
This is confirmed by a large increase in perfusionafter treatment(pre-treatmentFp = 6.7 ml/100ml/min,
post-treatment Fp =20.5 ml/100ml/min).
This patient reported significant treatment effects following chemotherapy.
Changes in perfusion before and after treatment...
Conclusion
Significant results
Normal tissue perfusion in the bladder is altered by neo-adjuvant chemotherapy.
Changes in perfusion observed in the rectum correlated with reported adverse effects.
Chemotherapy effects
Chemotherapy leads to cell death and reduces tumour neovascularisation.
This affects normal tissues as well as tumour leading to tissue toxicity and resulting inshort- and long-term inflammatory effects on the bladder and bowel,
such as haemorrhagic cystitis,
urinary retention,
haematuria,
dysuria,
diarrhoea and constipation [4,5].
Comparisons with other studies
Few studies have investigated relationships between DCE-MRI parameters in...
References
[1]CRUK.
Bladder cancer - survival statistics for England and Wales.
Vol 2009: Statistical information team,
Cancer Research UK; 2009.
[2]MacVicar D.
Carcinoma of the bladder: Cambridge University Press; 2008.
[3]Brix G,
Kiessling F,
Lucht R,
et al. Microcirculation and microvasculature in breast tumors: pharmacokinetic analysis of dynamic MR image series.
Magn Reson Med 2004;52:420-429.
[4]Chan TY,
Epstein JI.
Radiation or chemotherapy cystitis with "pseudocarcinomatous" features.
Am J Surg Pathol 2004;28:909-913.
[5]Wong-You-Cheong JJ,
Woodward PJ,
Manning MA,
et al. From the archives of the AFIP: Inflammatory...