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Vol. 85, No. 1, 2010
Issue release date: July 2010
Free Access
Urol Int 2010;85:1–10
(DOI:10.1159/000318985)

Imaging Studies in Metastatic Urogenital Cancer Patients Undergoing Systemic Therapy: Recommendations of a Multidisciplinary Consensus Meeting of the Association of Urological Oncology of the German Cancer Society

Heidenreich A.a · Albers P.b · Classen J.f · Graefen M.h · Gschwend J.c · Kotzerke J.i · Krege S.d · Lehmann J.j · Rohde D.e · Schmidberger H.g · Uder M.k · Zeeb H.l
Departments of Urology,aRWTH University, Aachen, bHeinrich Heine University, Düsseldorf, c Technical University, Munich, dKrankenhaus Maria Hilf, Krefeld, and eKatholisches Krankenhaus Duisburg Zentrum, Duisburg; Departments of Radiation Oncology, fSt. Vincentius Hospital, Karlsruhe, and gJohannes Gutenberg University, Mainz; hMartini-Klinik, University Hospital, Hamburg; iDepartment of Nuclear Medicine, Carl Gustav Carus University, Dresden; jUrologist, Kiel; kDepartment of Radiology, University Hospital, Erlangen; lDepartment of Biostatistics, Johannes Gutenberg University, Mainz, Germany
email Corresponding Author

Abstract

Introduction: Imaging studies are an integral and important diagnostic modality to stage, to monitor and follow-up patients with metastatic urogenital cancer. The currently available guidelines on diagnosis and treatment of urogenital cancer do not provide the clinician with evidence-based recommendations for daily practice. Objectives: To develop scientifically valid recommendations with regard to the most appropriate imaging technique and the most useful time interval in metastatic urogenital cancer patients undergoing systemic therapy. Methods: A systematic literature review was performed searching MedLine, Embase and Web of Science databases using the terms prostate, renal cell, bladder and testis cancer in combination with the variables lymph node, lung, liver, bone metastases, chemotherapy and molecular therapy, and the search terms computed tomography, magnetic resonance imaging and positron emission tomography were applied. A total of 11,834 records were retrieved from all databases. The panel reviewed the records to identify articles with the highest level of evidence using the recommendation of the US Agency for Health Care Policy and Research. Conclusions: Contrast-enhanced computed tomography remains the standard imaging technique for monitoring of pulmonary, hepatic and lymph node metastases. Bone scintigraphy is still the most widely used imaging technique for the detection and follow-up of osseous lesions. For clinical trials it might be replaced by either PET-CT or MRI of the skeletal axis. Response assessment for patients treated with cytotoxic regime is best performed by the RECIST/WHO criteria; treatment response to molecular triggered therapy is best assessed by CT evaluating decrease in tumor size and density. Cross-sectional imaging studies for response assessment might be obtained after each 2 cycles of systemic therapy to early stratify responders from non-responders.


 goto top of outline Key Words

  • Bladder cancer
  • Computed tomography
  • Germ cell tumors
  • Magnetic resonance imaging
  • PET-CT
  • Prostate cancer
  • Renal cell cancer
  • Skeletal scintigraphy
  • Testis cancer
  • Therapy response assessment

 goto top of outline Abstract

Introduction: Imaging studies are an integral and important diagnostic modality to stage, to monitor and follow-up patients with metastatic urogenital cancer. The currently available guidelines on diagnosis and treatment of urogenital cancer do not provide the clinician with evidence-based recommendations for daily practice. Objectives: To develop scientifically valid recommendations with regard to the most appropriate imaging technique and the most useful time interval in metastatic urogenital cancer patients undergoing systemic therapy. Methods: A systematic literature review was performed searching MedLine, Embase and Web of Science databases using the terms prostate, renal cell, bladder and testis cancer in combination with the variables lymph node, lung, liver, bone metastases, chemotherapy and molecular therapy, and the search terms computed tomography, magnetic resonance imaging and positron emission tomography were applied. A total of 11,834 records were retrieved from all databases. The panel reviewed the records to identify articles with the highest level of evidence using the recommendation of the US Agency for Health Care Policy and Research. Conclusions: Contrast-enhanced computed tomography remains the standard imaging technique for monitoring of pulmonary, hepatic and lymph node metastases. Bone scintigraphy is still the most widely used imaging technique for the detection and follow-up of osseous lesions. For clinical trials it might be replaced by either PET-CT or MRI of the skeletal axis. Response assessment for patients treated with cytotoxic regime is best performed by the RECIST/WHO criteria; treatment response to molecular triggered therapy is best assessed by CT evaluating decrease in tumor size and density. Cross-sectional imaging studies for response assessment might be obtained after each 2 cycles of systemic therapy to early stratify responders from non-responders.

Copyright © 2010 S. Karger AG, Basel


 goto top of outline References
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  4. Oosterlinck W, Lobel B, Jakse G, Malmström PU, Stöckle M, Sternberg C; European Association of Urology (EAU) Working Group on Oncological Urology: Guidelines on bladder cancer. Eur Urol 2002;41:105–112.
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  7. Therasse P, Eisenhauer EA, Verweij J: RECIST revisited: a review of validation studies on tumour assessment. Eur J Cancer 2006;42:1031–1039.
  8. Husband JE, Schwartz LH, Spencer J, Ollivier L, King DM, Johnson R, Reznek R; International Cancer Imaging Society: Evaluation of the response to treatment of solid tumours: a consensus statement of the International Cancer Imaging Society. Br J Cancer 2004;90:2256–2260.
  9. Wahl RL, Jacene H, Kasamon Y, Lodge MA: From RECIST to PERCIST: evolving considerations for PET response criteria in solid tumors. J Nucl Med 2009;50(suppl 5):122S–150S.

    External Resources

  10. Weber WA: Assessing tumor response to therapy. J Nucl Med 2009;50:1S–10S.
  11. Weber WA: Positron emission tomography as an imaging biomarker. J Clin Oncol 2006;24:3282–3292.
  12. Hall EJ, Brenner DJ: Cancer risks from diagnostic radiology. Br J Radiol 2008;965:362–378.

    External Resources

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 goto top of outline Author Contacts

Prof. Dr. med. Axel Heidenreich
Department of Urology, RWTH University Aachen
Pauwelsstrasse 30
DE–52074 Aachen (Germany)
Tel. +49 241 808 9377, Fax +49 241 802 441, E-Mail aheidenreich@ukaachen.de


 goto top of outline Article Information

Published online: July 26, 2010
Number of Print Pages : 10
Number of Figures : 0, Number of Tables : 4, Number of References : 65


 goto top of outline Publication Details

Urologia Internationalis

Vol. 85, No. 1, Year 2010 (Cover Date: July 2010)

Journal Editor: Wirth M.P. (Dresden), Porena M. (Perugia), Hakenberg O.W. (Rostock), Castro-Diaz D. (Santa Cruz de Tenerife)
ISSN: 0042-1138 (Print), eISSN: 1423-0399 (Online)

For additional information: http://www.karger.com/UIN


Copyright / Drug Dosage / Disclaimer

Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher or, in the case of photocopying, direct payment of a specified fee to the Copyright Clearance Center.
Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in goverment regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.
Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.

Abstract

Introduction: Imaging studies are an integral and important diagnostic modality to stage, to monitor and follow-up patients with metastatic urogenital cancer. The currently available guidelines on diagnosis and treatment of urogenital cancer do not provide the clinician with evidence-based recommendations for daily practice. Objectives: To develop scientifically valid recommendations with regard to the most appropriate imaging technique and the most useful time interval in metastatic urogenital cancer patients undergoing systemic therapy. Methods: A systematic literature review was performed searching MedLine, Embase and Web of Science databases using the terms prostate, renal cell, bladder and testis cancer in combination with the variables lymph node, lung, liver, bone metastases, chemotherapy and molecular therapy, and the search terms computed tomography, magnetic resonance imaging and positron emission tomography were applied. A total of 11,834 records were retrieved from all databases. The panel reviewed the records to identify articles with the highest level of evidence using the recommendation of the US Agency for Health Care Policy and Research. Conclusions: Contrast-enhanced computed tomography remains the standard imaging technique for monitoring of pulmonary, hepatic and lymph node metastases. Bone scintigraphy is still the most widely used imaging technique for the detection and follow-up of osseous lesions. For clinical trials it might be replaced by either PET-CT or MRI of the skeletal axis. Response assessment for patients treated with cytotoxic regime is best performed by the RECIST/WHO criteria; treatment response to molecular triggered therapy is best assessed by CT evaluating decrease in tumor size and density. Cross-sectional imaging studies for response assessment might be obtained after each 2 cycles of systemic therapy to early stratify responders from non-responders.



 goto top of outline Author Contacts

Prof. Dr. med. Axel Heidenreich
Department of Urology, RWTH University Aachen
Pauwelsstrasse 30
DE–52074 Aachen (Germany)
Tel. +49 241 808 9377, Fax +49 241 802 441, E-Mail aheidenreich@ukaachen.de


 goto top of outline Article Information

Published online: July 26, 2010
Number of Print Pages : 10
Number of Figures : 0, Number of Tables : 4, Number of References : 65


 goto top of outline Publication Details

Urologia Internationalis

Vol. 85, No. 1, Year 2010 (Cover Date: July 2010)

Journal Editor: Wirth M.P. (Dresden), Porena M. (Perugia), Hakenberg O.W. (Rostock), Castro-Diaz D. (Santa Cruz de Tenerife)
ISSN: 0042-1138 (Print), eISSN: 1423-0399 (Online)

For additional information: http://www.karger.com/UIN


Copyright / Drug Dosage

Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher or, in the case of photocopying, direct payment of a specified fee to the Copyright Clearance Center.
Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in goverment regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.
Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.

References

  1. Albers P, Albrecht W, Algaba F, Bokemeyer C, Cohn-Cedermark G, Horwich A, Klepp O, Laguna MP, Pizzocaro G: Guidelines on testicular cancer. Eur Urol 2005;48:885–894.
  2. Heidenreich A, Aus G, Bolla M, Joniau S, Matveev VB, Schmid HP, Zattoni F; European Association of Urology: EAU guidelines on prostate cancer. Eur Urol 2008;53:68–80.
  3. Ljungberg B, Hanbury DC, Kuczyk MA, Merseburger AS, Mulders PF, Patard JJ, Sinescu IC; European Association of Urology Guideline Group for renal cell carcinoma: Renal cell carcinoma guideline. Eur Urol 2007;51:1502–1510.
  4. Oosterlinck W, Lobel B, Jakse G, Malmström PU, Stöckle M, Sternberg C; European Association of Urology (EAU) Working Group on Oncological Urology: Guidelines on bladder cancer. Eur Urol 2002;41:105–112.
  5. Solsona E, Algaba F, Horenblas S, Pizzocaro G, Windahl T; European Association of Urology: EAU guidelines on penile cancer. Eur Urol 2004;46:1–8.
  6. Therasse P, Arbuck SG, Eisenhauer EA, Wanders J, Kaplan RS, Rubinstein L, Verweij J, Van Glabbeke M, van Oosterom AT, Christian MC, Gwyther SG: New guidelines to evaluate the response to treatment in solid tumors. European Organization for Research and Treatment of Cancer, National Cancer Institute of the United States, National Cancer Institute of Canada. J Natl Cancer Inst 2000;92:205–216.
  7. Therasse P, Eisenhauer EA, Verweij J: RECIST revisited: a review of validation studies on tumour assessment. Eur J Cancer 2006;42:1031–1039.
  8. Husband JE, Schwartz LH, Spencer J, Ollivier L, King DM, Johnson R, Reznek R; International Cancer Imaging Society: Evaluation of the response to treatment of solid tumours: a consensus statement of the International Cancer Imaging Society. Br J Cancer 2004;90:2256–2260.
  9. Wahl RL, Jacene H, Kasamon Y, Lodge MA: From RECIST to PERCIST: evolving considerations for PET response criteria in solid tumors. J Nucl Med 2009;50(suppl 5):122S–150S.

    External Resources

  10. Weber WA: Assessing tumor response to therapy. J Nucl Med 2009;50:1S–10S.
  11. Weber WA: Positron emission tomography as an imaging biomarker. J Clin Oncol 2006;24:3282–3292.
  12. Hall EJ, Brenner DJ: Cancer risks from diagnostic radiology. Br J Radiol 2008;965:362–378.

    External Resources

  13. Brenner DJ, Hall EJ: Computed tomography – an increasing source of radiation exposure. N Engl J Med 2007;357:2277–2284.
  14. Brix G, Nissen-Meyer S, Lechel U, Nissen-Meyer J, Griebel J, Nekolla EA, Becker C, Reiser M: Radiation exposures of cancer patients from medical X-rays: how relevant are they for individual patients and population exposure? Eur J Radiol 2009;72:342–347.
  15. Weisbord SD, Mor MK, Resnick AL, et al: Prevention, incidence and outcomes of contrast-induced acute kidney injury. Arch Int Med 2008;168:1325–1332.
  16. Singh J, Daftary A: Iodinated contrast media and their adverse reactions. J Nucl Med Technol 2008;36:69–74.
  17. Wiginton CD, Kelly B, Oto A, et al: Gadolinium-based contrast exposure, nephrogenic systemic fibrosis and gadolinium detection in tissue. AJR Am J Roentgenol 2008;190:1060–1068.
  18. Girvin F, Ko JP: Pulmonary nodules: detection, assessment and CAD. AJR Am J Roentgenol 2008;191:1057–1069.
  19. Wormanns D, Ludwig K, Beyer F, Heindel W, Diederich S: Detection of pulmonary nodules at multirow-detector CT: effectiveness of double reading to improve sensitivity at standard-dose and low-dose chest CT. Eur Radiol 2005;15:14–22.
  20. Parsons AM, Detterbeck FC, Parler LA: Accuracy of helical CT in the detection of pulmonary metastases: is intraoperative palpation still necessary? Ann Thorac Surg 2004;78:1910–1916.
  21. Pfannschmidt J, Bischoff M, Muley T, et al: Diagnosis of pulmonary metastases with helical CT: the effect of imaging techniques. Thorac Cardiovasc Surg 2008;56:471–475.
  22. Schröder T, Rühm SG, Debatin JF, Ladd ME, Barkhausen J, Goehde SC: Detection of pulmonary nodules using 2D HASTE MR sequence: comparison with MDCT. AJR Am J Roentgenol 2005;185:979–984.
  23. Jones EC, Chezmar JL, Nelson RC, Bernardino ME: The frequency and significance of small (less than or equal to 15 mm) hepatic lesions detected by CT. AJR Am J Roentgenol 1992;158:535–539.
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