Journal of Cancer Research and Clinical Oncology

, Volume 142, Issue 1, pp 187–194 | Cite as

Comparing RECIST with EORTC criteria in metastatic bladder cancer

  • Hakan Öztürk
Original Article – Cancer Research



To compare RECIST and EORTC criteria in an evaluation of response to therapy in metastatic bladder cancer and to assess their influence on decisions to administer additional therapy.

Materials and methods

A total of 42 untreated patients (38 male, 4 female) with metastatic bladder cancer were included in the study, which took place between July 2007 and April 2013. The mean age was 66.1 ± 9.93 years (range 41–84 years). A total of 144 metastatic foci were evaluated using multislice CT and 18FDG-PET/CT before and after first-line chemotherapy. The locations, sizes, numbers and SUVmax of the metastatic foci before and after chemotherapy were recorded, and the response to therapy was evaluated separately using RECIST and EORTC criteria, after which a statistical comparison was made.


According to the RECIST and EORTC criteria, the rate of complete remission (CR) was 9.5 and 16.6 %, the rate of partial remission (PR) was 28.6 and 40.5 %, the rate of stable disease (SD) was 23.8 and 14.3 %, and the rate of progressive disease (PD) was 31.0 and 28.6 %, respectively. The overall response rate (ORR) was 38.1 versus 57.1 %, respectively, and there were no differences between the two criteria in terms of their detection of progressive disease. The rate of SD was higher with RECIST criteria; however, the difference between the two criteria was not significant in terms of PR and CR.


A group of patients that had been determined as having a SD according to RECIST criteria were grouped as PR and/or CR according to EORTC criteria. Additional chemotherapy protocols can be used in second-line chemotherapy and/or cisplatin-resistant patients, according to RECIST criteria. In evaluating the response to first-line chemotherapy for metastatic bladder cancer, EORTC criteria, using 18FDG-PET/CT scans, can be considered as a more applicable and accurate diagnostic tool. The anatomical findings obtained through imaging methods and from functional/metabolic data obtained by PET/CT can be useful in the planning of second- or third-line chemotherapy, and a high accuracy in re-staging can spare patients from second-line or even third-line chemotherapy.


Metastatic bladder cancer Chemotheraphy Response to chemotheraphy RECIST EORTC PET/CT 


Compliance with ethical standards

Conflict of interest

The authors declare that they have no competing interests. Financial support has not been received.


  1. Apolo AB, Riches J, Schöder H, Akin O, Trout A, Milowsky MI et al (2010) Clinical value of fluorine-18 2-fluoro-2-deoxy-d-glucose positron emission tomography/computed tomography in bladder cancer. J Clin Oncol 28:3973–3978PubMedPubMedCentralCrossRefGoogle Scholar
  2. Bajorin DF, Dodd PM, Mazumdar M et al (1999) Long-term survival in metastatic transitional-cell carcinoma and prognostic factors predicting outcome of therapy. J Clin Oncol 17:3173–3181PubMedGoogle Scholar
  3. Barentsz JO, Engelbrecht MR, Witjes JA et al (1999) MR imaging of the male pelvis. Eur Radiol 9(9):1722–1736PubMedCrossRefGoogle Scholar
  4. Bellmunt J, Albiol S, de Olano AR, Pujadas J, Maroto P, Spanish Oncology Genitourinary Group (SOGUG) (2006) Gemcitabine in the treatment of advanced transitional cell carcinoma of the urothelium. Ann Oncol 17:113–117CrossRefGoogle Scholar
  5. Bellmunt J, Choueiri TK, Fougeray R, Schutz FA, Salhi Y, Winquist E et al (2010) Prognostic factors in patients with advanced transitional cell carcinoma of the urothelial tract experiencing treatment failure with platinum-containing regimens. J Clin Oncol 28(11):1850–1855 (Epub 2010 Mar 15) PubMedCrossRefGoogle Scholar
  6. Bouchelouche K, Turkbey B, Choyke PL (2012) PET/CT and MRI in bladder cancer. J Cancer Sci Ther S14(1):7692. doi: 10.4172/1948-5956.S14-001 PubMedGoogle Scholar
  7. Drieskens O, Oyen R, Van Poppel H, Vankan Y, Flamen P, Mortelmans L (2005) FDG-PET for preoperative staging of bladder cancer. Eur J Nucl Med Mol Imaging 32:1412–1417PubMedCrossRefGoogle Scholar
  8. El Fakhri G, Surti S, Trott CM et al (2011) Improvement in lesion detection with whole-body oncologic time-of-flight PET. J Nucl Med 52:347–353PubMedPubMedCentralCrossRefGoogle Scholar
  9. Folio L, Derderian V, Steinberg SM, Turkbey E, Apolo AB (2014) Assessing tumor response using CT density-volume trajectory in metastatic bladder cancer. J Clin Oncol 32:5s (suppl; abstr 4539) CrossRefGoogle Scholar
  10. Heidenreich A, Albers P, Classen J, Graefen M, Gschwend J, Kotzerke J et al (2010) 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. Urol Int 85(1):1–10. doi: 10.1159/000318985 (Epub 2010 Jul 26) PubMedCrossRefGoogle Scholar
  11. Jadvar H, Quan V, Henderson RW, Conti PS (2008) [F-18]-Fluorodeoxyglucose PET and PET-CT in diagnostic imaging evaluation of locally recurrent and metastatic bladder transitional cell carcinoma. Int J Clin Oncol 13:42–47PubMedPubMedCentralCrossRefGoogle Scholar
  12. Jensen TK, Holt P, Gerke O, Riehmann M, Svolgaard B et al (2011) Preoperative lymph-node staging of invasive urothelial bladder cancer with 18F-fluorodeoxyglucose positron emission tomography/computed axial tomography and magnetic resonance imaging: correlation with histopathology. Scand J Urol Nephrol 45:122–128PubMedCrossRefGoogle Scholar
  13. Jones EC, Chezmar JL, Nelson RC, Bernardino ME (1992) The frequency and significance of small (less than or equal to 15 mm) hepatic lesions detected by CT. AJR Am J Roentgenol 158:535–539PubMedCrossRefGoogle Scholar
  14. Kibel AS, Dehdashti F, Katz MD, Klim AP, Grubb RL, Humphrey PA et al (2009) Prospective study of 18F fluorodeoxyglucose positron emission tomography/computed tomography for staging of muscle-invasive bladder carcinoma. J Clin Oncol 27:4314–4320PubMedPubMedCentralCrossRefGoogle Scholar
  15. Liu IJ, Lai YH, Espiritu JI, Segall GM, Srinivas S et al (2006) Evaluation of fluorodeoxyglucose positron emission tomography imaging in metastatic transitional cell carcinoma with and without prior chemotherapy. Urol Int 77:69–75PubMedCrossRefGoogle Scholar
  16. Lodde M, Lacombe L, Friede J, Morin F, Saourine A et al (2010) Evaluation of fluorodeoxyglucose positron-emission tomography with computed tomography for staging of urothelial carcinoma. BJU Int 106:658–663PubMedCrossRefGoogle Scholar
  17. Lu YY, Chen JH, Liang JA, Wang HY, Lin CC, Lin WY et al (2012) Clinical value of FDG PET or PET/CT in urinary bladder cancer: a systemic review and meta-analysis. Eur J Radiol 81:2411–2416PubMedCrossRefGoogle Scholar
  18. Mertens LS, Mir MC, Scott AM, Lee ST, Fioole-Bruining A, Vegt E et al (2014) 18F-fluorodeoxyglucose-positron emission tomography/computed tomography aids staging and predicts mortality in patients with muscle-invasive bladder cancer. Urology 83(2):393–398. doi: 10.1016/j.urology.2013.10.032 PubMedCrossRefGoogle Scholar
  19. Morisawa N, Koyama T, Togashi K (2006) Metastatic lymph nodes in urogenital cancers: contribution of imaging findings. Abdom Imaging 31:620–629PubMedCrossRefGoogle Scholar
  20. Onishi H, Murakami T, Kim T, Hori M, Iannaccone R, Kuwabara M et al (2006) Hepatic metastases: detection with multi-detector row CT, SPIO-enhanced MR imaging, and both techniques combined. Radiology 239:131–138PubMedCrossRefGoogle Scholar
  21. Pfannschmidt J, Bischoff M, Muley T et al (2008) Diagnosis of pulmonary metastases with helical CT: the effect of imaging techniques. Thorac Cardiovasc Surg 56:471–475PubMedCrossRefGoogle Scholar
  22. Ploeg M, Aben KK, Kiemeney LA (2009) The present and future burden of urinary bladder cancer in the world. World J Urol 27(3):289–293PubMedPubMedCentralCrossRefGoogle Scholar
  23. Schmidt GP, Schoenberg SO, Schmid R, Stahl R, Tiling R, Becker CR, Reiser MF, Baur-Melnyk A (2007) Screening for bone metastases: whole-body MRI using a 32-channel system versus dual-modality PET-CT. Eur Radiol 17:939–949PubMedCrossRefGoogle Scholar
  24. Siegel R, Ward E, Brawley O et al (2011) Cancer statistics, 2011: the impact of eliminating socioeconomic and racial disparities on premature cancer deaths. CA Cancer J Clin 61:212–236PubMedCrossRefGoogle Scholar
  25. Siegel R, Naishadham D, Jemal A (2013) Cancer statistics, 2013. CA Cancer J Clin 63:11–30PubMedCrossRefGoogle Scholar
  26. Stein JP, Lieskovsky G, Cote R, Groshen S, Feng AC et al (2001) Radical cystectomy in the treatment of invasive bladder cancer: long-term results in 1,054 patients. J Clin Oncol 19:666–675PubMedGoogle Scholar
  27. Sternberg CN, Yagoda A, Scher HI, Watson RC, Ahmed T, Weiselberg LR et al (1985) Preliminary results of M-VAC (methotrexate, vinblastine, doxorubicin and cisplatin) for transitional cell carcinoma of the urothelium. J Urol 133(3):403–407PubMedGoogle Scholar
  28. Sternberg CN, Pansadoro V, Calabrò F et al (2003) Can patient selection for bladder preservation be based on response to chemotherapy? Cancer 97(7):1644–1652PubMedCrossRefGoogle Scholar
  29. Swinnen G, Maes A, Pottel H, Vanneste A, Billiet I et al (2010) FDG-PET/CT for the preoperative lymph node staging of invasive bladder cancer. Eur Urol 57:641–647PubMedCrossRefGoogle Scholar
  30. Taguchi S, Nakagawa T, Hattori M, Niimi A, Nagata M, Kawai T et al (2013) Prognostic factors for metastatic urothelial carcinoma undergoing cisplatin-based salvage chemotherapy. Jpn J Clin Oncol 43(9):923–928. doi: 10.1093/jjco/hyt096 (Epub 2013 Jul 25) PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2015

Authors and Affiliations

  1. 1.Department of Urology, School of MedicineSifa UniversityIzmirTurkey
  2. 2.Basmane Hospital of Sifa UniversityKonakTurkey

Personalised recommendations