PMC8222973_01
Imaging of the patient over the course of therapy. (A) The axial pelvic CT image before treatment demonstrated a mass was about 3.0 cm arising from the anterior wall of the bladder and the perivesical fat was invaded. (B) After two cycles of neoadjuvant therapy, the axial image from dynamic contrast-enhanced pelvic MRI indicated the thickness of enhanced anterior wall of the bladder decreased. (C) After four cycles of neoadjuvant therapy, the axial T2W image from pelvic MRI showed the light thickening of the anterior wall was persisting, but no node or tumor was found. (D) After concurrent chemoradiotherapy plus pembrolizumab, the axial contrast-enhanced MRI on arterial phase showed the bladder was normal with no sign of tumor recurrence. (E) The axial contrast-enhanced MRI on arterial phase still showed no tumor in the bladder at the last follow-up on February 20, 2021.
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Pelvic computed tomography (CT) revealed an irregular mass measuring 3.0 cm x 2.1 cm located at the anterior wall of the bladder ( Figure 1A ). After two cycles of neoadjuvant therapy, pelvic MRI showed that the thickness of the anterior wall of the bladder was lessened, and the thickest area was only 0.5 cm ( Figure 1B ). The imaging results showed that light thickening of anterior wall was persisting, but no node or obvious tumor was shown ( Figure 1C ), and the result of urine cytology analysis was negative. To evaluate the effect of chemoradiotherapy, the patient received pelvic MRI plus chest/abdominal CT on January 7 ( Figure 1D ) and cystoscopy on January 10, 2020. On February 20, 2021, MRI results showed that there was still no tumor in the bladder ( Figure 1E ).
The mutation frequency of the RB1 gene in the urine of the patient.
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The results showed that the mutation frequency of RB1 decreased significantly ( Figure 2 ).
Timeline of patient treatment.
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The overall treatment timeline is shown in  Figure 3 .