Please use this identifier to cite or link to this item: http://hdl.handle.net/2445/135643
Title: Questioning the Value of Fluorodeoxyglucose Positron Emission Tomography for Residual Lesions After Chemotherapy for Metastatic Seminoma: Results of an International Global Germ Cell Cancer Group Registry
Author: Cathomas, Richard
Klingbiel, Dirk
Bernard, Brandon
Lorch, Anja
García del Muro Solans, Xavier
Morelli, Franco
Giorgi, Ugo de
Fedyanin, Mikhail
Oing, Christoph
Haugnes, Hege Sagstuen
Hentrich, Marcus
Fankhauser, Christian
Gillessen, Silke
Beyer, Jörg
Keywords: Quimioteràpia
Tomografia per emissió de positrons
Càncer
Chemotherapy
Positron emission tomography
Cancer
Issue Date: 4-Oct-2018
Publisher: American Society of Clinical Oncology
Abstract: Purpose Residual lesions after chemotherapy are frequent in metastatic seminoma. Watchful waiting is recommended for lesions < 3 cm as well as for fluorodeoxyglucose (FDG) positron emission tomography (PET)-negative lesions ≥ 3 cm. Information on the optimal management of PET-positive residual lesions ≥ 3 cm is lacking. Patients and Methods We retrospectively identified 90 patients with metastatic seminoma with PET-positive residual lesions after chemotherapy. Patients with elevated α-fetoprotein or nonseminomatous histology were excluded. We analyzed the post-PET management and its impact on relapse and survival and calculated the positive predictive value (PPV) for PET. Results Median follow-up time was 29 months (interquartile range [IQR], 10 to 62 months). Median diameter of the largest residual mass was 4.9 cm (range, 1.1 to 14 cm), with masses located in the retroperitoneum (77%), pelvis (16%), mediastinum (17%), and/or lung (3%). Median time from the last day of chemotherapy to PET was 6.9 weeks (IQR, 4.4 to 9.9 weeks). Post-PET management included repeated imaging in 51 patients (57%), resection in 26 patients (29%), biopsy in nine patients (10%) and radiotherapy in four patients (4%). Histology of the resected specimen was necrosis in 21 patients (81%) and vital seminoma in five patients (19%). No biopsy revealed vital seminoma. Relapse or progression occurred in 15 patients (17%) after a median of 3.7 months (IQR, 2.5 to 4.9 months) and was found in 11 (22%) of 51 patients on repeated imaging, in two (8%) of 26 patients after resection, and in two (22%) of nine patients after biopsy. All but one patient who experienced relapse were successfully treated with salvage therapy. The PPV for FDG-PET was 23%. Conclusion FDG-PET has a low PPV for vital tumor in residual lesions after chemotherapy in patients with metastatic seminoma. This cautions against clinical decisions based on PET positivity alone.
Note: Reproducció del document publicat a: https://doi.org/10.1200/JCO.18.00210
It is part of: Journal of Clinical Oncology, 2018, vol. 36, num. 34, p. 3381-3387
URI: http://hdl.handle.net/2445/135643
Related resource: https://doi.org/10.1200/JCO.18.00210
ISSN: 0732-183X
Appears in Collections:Articles publicats en revistes (Ciències Clíniques)

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