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Abstract
Introduction. At the current stage of medical development, radiotherapy is one of the four components of successful treatment in oncology. However, radiation inevitably affects not only the tumor mass but also the surrounding healthy organs and tissues. When pelvic organs are irradiated, the bladder is the critical and most affected organ, sensitive to even low doses of radiation. Signs of acute radiation-induced cystitis (RIC) may be underestimated and therefore not recorded in medical records, while patients may develop late radiation-induced bladder lesions. Late RICs are the result of an incomplete regenerative response, resulting in progressive damage to the bladder tissue and immunohistological changes. Late complications of pelvic radiation therapy account for up to 7 % of emergency hospital admissions in urology clinics.
Aim. To determine the role of positron emission tomography combined with computed tomography (PET-CT) in the diagnosis of chronic radiation reactions in late bladder injury in an experimental setting. The study included 48 experimental animals in which acute RIC had previously been modelled. The PET-CT study was performed before and 9 days after the end of RIC treatment. 11C-labelled choline was administered as a radiopharmaceutical in a volume of 0.4-1.0 ml per 100 g of animal body weight. The size of the lesion area S (mm2) and the intensity of radiopharmaceutical accumulation in the SUV in the bladder wall were used to assess the chronicity of acute RIC.
Results. The results of repeated PET-CT allowed us to formulate a prognosis for the recovery or chronicity of RIC. After autopsy, it was found that 16 out of 17 animals with good prognosis but without additional therapy showed no signs of cystitis (94.3 %), and with continued therapy, signs of cystitis were absent in 100 % of cases. In 13 animals with a poor prognosis according to the PET-CT data, chronic cystitis was detected and histologically confirmed in 100 %.
Conclusion. 1. PET-CT with 11C-labelled choline is prognostically reliable for assessing the likelihood of RIC chronicity in experimental animals. 2. A 15-20 % change in any of the S indicators or a 15 % change in SUV, or stabilization of any of these indicators, is a prognostic sign of chronicity of RIC.
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