Impact of Positron Emission Tomography (PET) Imaging in Muscle-invasive Urothelial Carcinoma of the Bladder Staging
Overview
- Phase
- Not Applicable
- Intervention
- Not specified
- Conditions
- Muscle-invasive Bladder Cancer
- Sponsor
- Ontario Clinical Oncology Group (OCOG)
- Enrollment
- 292
- Locations
- 6
- Primary Endpoint
- Treatment received
- Status
- Completed
- Last Updated
- last year
Overview
Brief Summary
Bladder cancer is the fifth most common cancer in Canada and there has been relatively little progress in altering its clinical course over the last three decades. One of the major problems identified in the management of this disease, is under staging of muscle invasive disease which can lead to suboptimal treatment and outcomes. PET-CT has the potential to more accurately stage MIBC than standard CT by detecting pelvic adenopathy and/or distant sites of disease that may not be found on standard imaging. In the former situation, more aggressive therapy with extended lymph node dissection and/or neoadjuvant chemotherapy prior to cystectomy can be offered. While in the latter situation patients can be spared the morbidity of a cystectomy performed in a setting of metastatic disease. This study will address whether PET-CT adds a clinically meaningful difference in care.
Detailed Description
A multicenter randomized controlled trial will be performed. Patients usually present with symptoms (e.g., painless hematuria). The urologist will perform cystoscopy and if urothelial cancer of the bladder is suspected, the patient is taken to the operating room for an examination under anesthesia (EUA) and a TURBT. If this shows muscle invasion then conventional staging with CT chest, abdomen, and pelvis is performed. The patient who has TNM Stage T2a-T4a N0-3 M0 is eligible to be enrolled in the trial. Eligible consenting patients will be randomized 2:1 to PET-CT or none (Control). The actual treatment received by the patient will be documented. The primary outcome measure is treatment received.
Investigators
Eligibility Criteria
Inclusion Criteria
- •Men and women with newly diagnosed muscle-invasive high grade urothelial carcinoma of the bladder (TNM stage T2a-T4a, N0-3, M0), who are eligible for either radical cystectomy or radiotherapy-based bladder conservation.
- •Being considered for treatment of curative intent.
Exclusion Criteria
- •Age \< 18 years.
- •ECOG performance status \>
- •Predominant histology (\>50% of specimen) involves non-urothelial cell carcinoma.
- •Prior partial cystectomy.
- •Prior pelvis surgery that obviates a completed extended lymphadenectomy (e.g., aorto-femoral/iliac bypass) or for whom the surgeon feels that their ability to perform a standard or extended pelvic node dissection would be compromised.
- •Contraindications to FDG PET-CT.
- •Inability to lie supine for imaging with PET-CT.
- •Inadequate hepatic function:
- •(i) Bilirubin \>1.5 X ULN and (ii) SGOT and Alkaline phosphatase \>3 X ULN
- •History of another invasive malignancy within the previous 5 years with the exception of non-melanoma skin cancer.
Outcomes
Primary Outcomes
Treatment received
Time Frame: 5 years
For patients with planned cystectomy, treatment received includes: avoidance of planned cystectomy and node dissection, an extended (vs standard) node dissection (or standard dissection when extended is the surgeon's usual practice), use of neoadjuvant chemotherapy (vs no neoadjuvant chemotherapy). For patients with planned bladder conservation, treatment received includes: avoidance of bladder and nodal radiation (vs bladder only or no radiation) and use of neoadjuvant chemotherapy (or not).
Secondary Outcomes
- Disease-free survival(5 years)
- Quality of life analysis(5 years)
- Overall survival(5 years)
- Health economic analysis(5 years)