1
|
Pandit K, Puri D, Yuen K, Yodkhunnatham N, Meagher M, Bagrodia A. Optimal imaging techniques across the spectrum of testicular cancer. Urol Oncol 2024:S1078-1439(24)00497-6. [PMID: 38960839 DOI: 10.1016/j.urolonc.2024.05.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2023] [Revised: 05/19/2024] [Accepted: 05/21/2024] [Indexed: 07/05/2024]
Abstract
Over the years, several imaging techniques have been used in the diagnosis and management of testicular cancer. We compartmentalize disease stages into preorchiectomy, stage 1, initial stage 2 and 3 and postchemotherapy stage 2 and 3. We then elaborate on various imaging modalities that are relevant to each of these stages. We also describe evolving imaging tools that have shown promise. We attempt to provide a comprehensive review of these techniques over the spectrum of testicular cancer.
Collapse
Affiliation(s)
- Kshitij Pandit
- Department of Urology, UC San Diego School of Medicine, La Jolla, California
| | - Dhruv Puri
- Department of Urology, UC San Diego School of Medicine, La Jolla, California
| | - Kit Yuen
- Department of Urology, UC San Diego School of Medicine, La Jolla, California
| | | | - Margaret Meagher
- Department of Urology, UC San Diego School of Medicine, La Jolla, California
| | - Aditya Bagrodia
- Department of Urology, UC San Diego School of Medicine, La Jolla, California.
| |
Collapse
|
2
|
De Pasquale MD, D'Angelo P, Crocoli A, Vallero SG, Bertolini P, Miele E, Terenziani M. Role of 18F-Fluorodeoxyglucose Positron Emission Tomography in Children With Germ Cell Tumor After Chemotherapy. J Pediatr Hematol Oncol 2024; 46:e272-e276. [PMID: 38912835 DOI: 10.1097/mph.0000000000002882] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2023] [Accepted: 04/10/2024] [Indexed: 06/25/2024]
Abstract
BACKGROUND/AIM 18F-fluoro-2-deoxyglucose positron emission tomography/computed tomography (18F-FDG PET/CT) is a diagnostic tool widely used in adult oncology and some pediatric oncological settings. There are no established recommendations for the use of this imaging modality in pediatric malignant germ cell tumors (mGCT), however. Our aim is to evaluate the role of 18F-FDG PET/CT in the restaging of mGCT after chemotherapy in children and adolescents. METHODS We retrospectively reviewed patients with mGCT treated in Associazione Italiana Ematologia Oncologia Pediatrica (AIEOP) centers who underwent 18F-FDG PET/CT between 2011 and 2021. RESULTS Seventeen patients (median age 13 y) were included in the study. In 14 patients, 18F-FDG PET/CT was performed at diagnosis; 12 showed pathologic uptake. The 2 18F-FDG PET/CT negative cases were histologically defined as yolk sac tumor (YST) and mixed (chorioncarcinoma, YST). Nine of the 12 patients who had pathologic 18F-FDG PET/CT at diagnosis repeated the examination after neoadjuvant chemotherapy, before, second look surgery. In 5 cases, no pathologic uptake was evident. Histology showed necrosis alone in 4 cases and necrosis and mature teratoma in 1. In 3 of the 6 cases with pathologic uptake (2 of 6 patients did not perform the examination at diagnosis), histology showed persistence of malignant component, whereas in the remaining 3 cases, necrosis and mature teratoma were present. CONCLUSION In our review of a series of children with mGCT, 18F-FDG PET/CT after neoadjuvant chemotherapy showed 1 of 5 false negatives and was unable to discriminate between residual malignant component and mature teratoma.
Collapse
Affiliation(s)
| | - Paolo D'Angelo
- Pediatric Hematology/Oncology Unit, A.R.N.A.S. Civico Di Cristina e Benfratelli, Palermo
| | | | - Stefano G Vallero
- Section of Pediatric Onco-Hematology, Department of Public Health and Pediatric Sciences, University of Turin, Turin
| | - Patrizia Bertolini
- Pediatric Hematology Oncology Unit, Azienda Ospedaliero Universitaria of Parma, Parma
| | - Evelina Miele
- Hematology/Oncology and Cell therapy Department, Ospedale Pediatrico Bambino Gesù- IRCCS, Roma
| | - Monica Terenziani
- Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, Milano, Italy
| |
Collapse
|
3
|
Wood GE, Chamberlain F, Tran B, Conduit C, Liow E, Nicol DL, Shamash J, Alifrangis C, Rajan P. Treatment de-escalation for stage II seminoma. Nat Rev Urol 2023:10.1038/s41585-023-00727-0. [PMID: 36882564 DOI: 10.1038/s41585-023-00727-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/31/2023] [Indexed: 03/09/2023]
Abstract
International Germ Cell Cancer Collaborative Group good-risk metastatic seminoma has cure rates of >95%. Within this risk group, patients with stage II disease exhibit the best oncological outcomes with the standard-of-care treatment strategies of radiotherapy or combination chemotherapy. However, these treatments can be associated with substantial early and late toxic effects. Therapy de-escalation aims to reduce treatment morbidity whilst preserving oncological outcomes. The evidence supporting such approaches is largely from non-randomized institutional data, and therefore this strategy is not recognized as standard of care. Current de-escalation approaches for stage II seminoma include single-agent chemotherapy, radiotherapy and surgery based on early data from clinical studies. Increased recognition of emerging data on treatment modification to reduce morbidity whilst maintaining cure rates and consideration of therapy de-escalation could improve patient survivorship outcomes.
Collapse
Affiliation(s)
- Georgina E Wood
- Department of Medical Oncology, University College London Hospitals NHS Foundation Trust, London, UK.,Department of Medical Oncology, Barts Health NHS Trust, London, UK
| | | | - Ben Tran
- Department of Medical Oncology, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia.,Division of Personalized Medicine, Walter and Eliza Hall Institute of Medical Research, Melbourne, Victoria, Australia
| | - Ciara Conduit
- Department of Medical Oncology, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia.,Division of Personalized Medicine, Walter and Eliza Hall Institute of Medical Research, Melbourne, Victoria, Australia
| | - Elizabeth Liow
- Division of Personalized Medicine, Walter and Eliza Hall Institute of Medical Research, Melbourne, Victoria, Australia
| | - David L Nicol
- Department of Urology, The Royal Marsden Hospital NHS Foundation Trust, London, UK
| | - Jonathan Shamash
- Department of Medical Oncology, Barts Health NHS Trust, London, UK
| | - Constantine Alifrangis
- Department of Medical Oncology, University College London Hospitals NHS Foundation Trust, London, UK. .,National Institute for Health Research University College London Hospitals Biomedical Research Centre, University College London Hospitals NHS Foundation Trust, London, UK.
| | - Prabhakar Rajan
- Centre for Cancer Cell and Molecular Biology, Barts Cancer Institute, Queen Mary University of London, London, UK. .,Division of Surgery and Interventional Science, University College London, London, UK. .,Department of Urology, Barts Health NHS Trust, London, UK. .,Department of Urology, University College London Hospitals NHS Foundation Trust, London, UK.
| |
Collapse
|
4
|
Dieckmann KP, Klemke M, Grobelny F, Radtke A, Dralle-Filiz I, Wülfing C, Belge G. Serum Levels of MicroRNA-371a-3p (M371) Can Predict Absence or Presence of Vital Disease in Residual Masses After Chemotherapy of Metastatic Seminoma. Front Oncol 2022; 12:889624. [PMID: 35600346 PMCID: PMC9121896 DOI: 10.3389/fonc.2022.889624] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2022] [Accepted: 04/11/2022] [Indexed: 11/13/2022] Open
Abstract
BackgroundRadiological evaluation of postchemotherapy residual masses of metastatic seminoma is characterized by poor diagnostic accuracy. Serum levels of microRNA-371a-3p (M371) involve high specificity and sensitivity for the primary diagnosis of seminoma. We evaluated if M371 levels can indicate the presence of vital disease in postchemotherapy residual masses in patients with metastatic seminoma.MethodsTwenty-three seminoma patients (median age 52 years) with residual masses had posttreatment measurements of serum M371 levels (group A), fourteen of whom had measurements also beforehand. The posttreatment results were compared with the clinical outcome during follow-up. Eleven patients with complete remission after treatment of metastatic seminoma (group B) and 33 men with non-malignant testicular diseases (group C) served as controls. M371 serum levels were measured by quantitative real-time PCR using miR-30b-5p as endogenous control. An evaluation was performed with descriptive statistical methods.ResultsTwenty-two patients of Group A had uneventful follow-up so far, twenty-one of whom had M371 level <5, and one other had a mildly elevated level below relative quantity (RQ) = 10. One patient with a level of RQ = 26.2 rapidly progressed. The median posttreatment M371 level of the non-progressing patients of group A is not significantly different from the median level of the control group with complete remission (B). Before treatment, the median M371 levels in groups A and B were 507.6 and 143.9, respectively. In both groups, significant drops in M371 levels resulted from treatment.ConclusionNormal M371 serum levels at the time of completion of treatment of metastatic seminoma indicate the absence of vital seminoma in residual masses, while elevated levels >RQ = 10 predict the presence of disease. The optimal timing of M371 measurement after chemotherapy and the appropriate cutoff level still need to be determined. Based on the present results, measuring serum M371 levels involves the potential of a novel tool for assessing postchemotherapy residual masses of metastatic seminoma.
Collapse
Affiliation(s)
- Klaus-Peter Dieckmann
- Department of Urology, Asklepios Klinik Altona, Hamburg, Germany
- Department of Urology, Albertinen Krankenhaus, Hamburg, Germany
| | - Markus Klemke
- Faculty of Biology & Chemistry, University of Bremen, Bremen, Germany
| | | | | | | | | | - Gazanfer Belge
- Faculty of Biology & Chemistry, University of Bremen, Bremen, Germany
- *Correspondence: Gazanfer Belge,
| |
Collapse
|
5
|
Abu-Salha YM, Ahlschlager L, Milowsky MI, Saunders K, Rose TL, Wobker SE, Bjurlin MA. Vigilance is key: Metastatic teratoma in an enlarging retroperitoneal mass after treatment of advanced seminoma – a case report. JOURNAL OF CLINICAL UROLOGY 2022. [DOI: 10.1177/20514158221075411] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
We present the case of a patient with pure seminoma in the orchiectomy specimen with retroperitoneal mass and a minimally elevated alpha fetoprotein (AFP). The patient received chemotherapy with positron emission tomography (PET) imaging demonstrating minimal fluorodeoxyglucose (FDG) uptake consistent with no viable tumour. Subsequent imaging revealed slow growth in the residual mass with a mildly elevated fluctuating AFP. A robotic-assisted laparoscopic retroperitoneal lymph node dissection was performed revealing metastatic teratoma. This case illustrates the potential for a missed or ‘burned out’ occult NSGCT in a patient with pure seminoma and the importance of post-treatment surveillance. In advanced seminoma, PET may be used to distinguish viable tumour from necrosis in post-chemotherapy residual masses. However, it is unable to distinguish between teratoma and necrosis in non-seminomatous germ cell tumours (NSGCT). Minimally elevated AFP could be a normal variant or signify a component of NSGCT in such cases. Level of evidence: 4
Collapse
Affiliation(s)
- Yousef M Abu-Salha
- Department of Urology, The University of North Carolina at Chapel Hill (UNC), USA
| | - Lauren Ahlschlager
- Department of Urology, The University of North Carolina at Chapel Hill (UNC), USA
- UNC School of Medicine, The University of North Carolina at Chapel Hill (UNC), USA
| | - Matthew I Milowsky
- Division of Oncology, The University of North Carolina at Chapel Hill (UNC), USA
- Lineberger Comprehensive Cancer Center, The University of North Carolina at Chapel Hill (UNC), USA
| | - Katherine Saunders
- Department of Pathology and Laboratory Medicine, The University of North Carolina at Chapel Hill (UNC), USA
| | - Tracy L Rose
- Division of Oncology, The University of North Carolina at Chapel Hill (UNC), USA
- Lineberger Comprehensive Cancer Center, The University of North Carolina at Chapel Hill (UNC), USA
| | - Sara E Wobker
- Lineberger Comprehensive Cancer Center, The University of North Carolina at Chapel Hill (UNC), USA
- Department of Pathology and Laboratory Medicine, The University of North Carolina at Chapel Hill (UNC), USA
| | - Marc A Bjurlin
- Department of Urology, The University of North Carolina at Chapel Hill (UNC), USA
- Lineberger Comprehensive Cancer Center, The University of North Carolina at Chapel Hill (UNC), USA
| |
Collapse
|
6
|
Raggi D, Bandini M, Giannatempo P, Farè E, Marandino L, Colecchia M, Calareso G, Padovano B, Serafini G, Alessi A, Necchi A. Prognostic Role of Early Interim Fluorodeoxyglucose Positron Emission Tomography in Patients With Advanced Seminoma Undergoing Standard Treatment. Clin Genitourin Cancer 2020; 19:237-245.e2. [PMID: 32980271 DOI: 10.1016/j.clgc.2020.08.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2020] [Revised: 08/03/2020] [Accepted: 08/08/2020] [Indexed: 01/12/2023]
Abstract
BACKGROUND Patients with advanced seminoma have an exceedingly favorable prognosis. Studies aiming to reduce the total treatment burden and side effects in patients with well-defined disease and very good prognosis are warranted. PATIENTS AND METHODS In a prospective observational study, patients with advanced stage seminoma were treated with bleomycin, etoposide, and cisplatin (BEP) or EP according to guidelines. Fluorodeoxyglucose with positron emission tomography and computed tomography (FDG-PET/CT) examinations were performed at baseline, after 2 cycles (PET/CT2) in all patients, and after chemotherapy at the physician's discretion. Disease response to treatment assessed by PET/CT was qualitatively evaluated by 2 independent nuclear medicine physicians. Contrast-enhanced CT scans were also performed according to guidelines (at baseline, after treatment, during follow-up). The study's primary endpoint was to evaluate the association between PET/CT2 findings and relapse-free survival. RESULTS From January 2009 to January 2017, a total of 75 consecutive patients were enrolled, of whom 70 were included for analysis. The clinical disease stage was IIA-B and IIC-III in 40% and 60%, respectively. By local assessment, 46 PET/CT2 scans (65.7%) were reported as negative, and 46% of these patients had stage IIC-III disease. Five-year relapse-free survival of PET/CT2-positive patients was 75% (95% confidence interval, 60-95) compared to 97.8% (95% confidence interval, 93.7-100) of PET/CT2-negative patients (P = .002). In univariate analyses, PET/CT2 was significantly associated with relapse-free survival (P = .02). CONCLUSIONS No residual FDG uptake after 2 cycles of conventional chemotherapy is prognostic in advanced seminoma, but it may be useful to optimize the standard prognostic risk groups and may be tested within larger prospective clinical trials of chemotherapy deescalation.
Collapse
Affiliation(s)
- Daniele Raggi
- Department of Medical Oncology, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Marco Bandini
- Unit of Urology, Urological Research Institute (URI), IRCCS Ospedale San Raffaele, Vita-Salute San Raffaele University, Milan, Italy
| | - Patrizia Giannatempo
- Department of Medical Oncology, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Elena Farè
- Department of Medical Oncology, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Laura Marandino
- Department of Medical Oncology, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Maurizio Colecchia
- Department of Pathology, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Giuseppina Calareso
- Department of Radiology, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Barbara Padovano
- Department of Nuclear Medicine, PET Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Gianluca Serafini
- Department of Nuclear Medicine, PET Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Alessandra Alessi
- Department of Nuclear Medicine, PET Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Andrea Necchi
- Department of Medical Oncology, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy.
| |
Collapse
|
7
|
PET/CT in Renal, Bladder, and Testicular Cancer. Clin Nucl Med 2020. [DOI: 10.1007/978-3-030-39457-8_24] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
|
8
|
Schriefer P, Hartmann M, Oechsle K, Meyer CP, Klutmann S, Fisch M, Bokemeyer C, Oing C. [Positron emission tomography in germ cell tumors in men : Possibilities and limitations]. Urologe A 2018; 58:418-423. [PMID: 30374517 DOI: 10.1007/s00120-018-0797-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
BACKGROUND Conventional radiographic imaging may fail to safely distinguish clinical stage I from stage IIA germ cell cancer, to localize isolated tumor marker relapses, and to equivocally identify the viability of postchemotherapy residual masses. OBJECTIVES To provide an overview of the diagnostic value and limitations of functional imaging by positron emission tomography with 2‑deoxy-2-[fluorine-18]fluoro-D-glucose with computed tomography (18F-FDG-PET-CT) in male germ cell cancer. MATERIALS AND METHODS A narrative review based on a literature search of PubMed/MEDLINE for original articles published from 1990-2018 and conference proceedings of ASCO (American Society of Clinical Oncology) and EAU (European Association of Urology) annual meetings 2014-2017 is presented. RESULTS 18F-FDG-PET-CT does not improve diagnostic accuracy compared to conventional CT imaging clinical stage (CS) I disease. Particularly PET-negativity of postchemotherapy residual masses of seminomas >3 cm in size guide decision-making against further additional treatment. Even PET-positive residues must not result in relapse. For nonseminoma, the value of PET imaging is reduced by potential mature teratoma components, which are commonly PET negative. CONCLUSIONS Current guidelines recommend 18F-FDG-PET-CT 6-8 weeks postchemotherapy for viability assessment of seminoma residues >3 cm in size. Exceptional circumstances, in which 18F-FDG-PET-CT may be helpful, include: (1) detection of active disease in CS IS, (2) viability assessment of residual masses >1 cm where complete secondary resection is impossible, (3) staging at marker relapse with unconspicuous conventional CT scan, (4) early response assessment during chemotherapy.
Collapse
Affiliation(s)
- P Schriefer
- Klinik und Poliklinik für Urologie, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Deutschland
| | - M Hartmann
- Klinik und Poliklinik für Urologie, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Deutschland
| | - K Oechsle
- Klinik für Onkologie, Hämatologie und Knochenmarktransplantation mit Abteilung für Pneumologie, Universitätsklinikum Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Deutschland
| | - C P Meyer
- Klinik und Poliklinik für Urologie, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Deutschland
| | - S Klutmann
- Klinik und Poliklinik für Diagnostische und Interventionelle Radiologie und Nuklearmedizin, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Deutschland
| | - M Fisch
- Klinik und Poliklinik für Urologie, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Deutschland
| | - C Bokemeyer
- Klinik für Onkologie, Hämatologie und Knochenmarktransplantation mit Abteilung für Pneumologie, Universitätsklinikum Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Deutschland
| | - C Oing
- Klinik für Onkologie, Hämatologie und Knochenmarktransplantation mit Abteilung für Pneumologie, Universitätsklinikum Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Deutschland.
| |
Collapse
|
9
|
Albano D, Caobelli F, Quartuccio N, Fiasconaro E, Messina M, Spada M, Alongi P. PET/CT for the diagnostic assessment of patients with testicular cancer. Clin Transl Imaging 2018. [DOI: 10.1007/s40336-018-0277-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
|
10
|
Kassem TW. Do we need 18F-FDG PET/CT scan in staging and management of testicular tumors? THE EGYPTIAN JOURNAL OF RADIOLOGY AND NUCLEAR MEDICINE 2016. [DOI: 10.1016/j.ejrnm.2016.03.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
|
11
|
Alotaibi M, Saadeddin A, Bazarbashi S, Alkhateeb S, Alghamdi A, Alghamdi K, Murshid E, Abusamra A, Rabah D, Ahmad I, Al-Mansour M, Alsharm A. Saudi Oncology Society and Saudi Urology Association combined clinical management guidelines for testicular germ cell tumors. Urol Ann 2016; 8:141-5. [PMID: 27141181 PMCID: PMC4839228 DOI: 10.4103/0974-7796.179240] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
This is an update to the previously published Saudi guidelines for the evaluation, medical, and surgical management of patients diagnosed with testicular germ cell tumors. It is categorized according to the stage of the disease using the tumor-node-metastasis staging system 7(th) edition. The guidelines are presented with supporting evidence level, they are based on comprehensive literature review, several internationally recognized guidelines, and the collective expertise of the guidelines committee members (authors) who were selected by the Saudi Oncology Society and Saudi Urological Association. Considerations to the local availability of drugs, technology and expertise have been regarded. These guidelines should serve as a roadmap for the urologists, oncologists, general physicians, support groups, and health care policy makers in the management of patients diagnosed with testicular germ cell tumors.
Collapse
Affiliation(s)
- Mohammed Alotaibi
- Department of Urology, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
| | - Ahmad Saadeddin
- Department of Oncology, King Abdulaziz Medical City, Riyadh, Saudi Arabia
| | - Shouki Bazarbashi
- Department of Oncology, Section of Medical Oncology, Oncology Center, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
| | - Sultan Alkhateeb
- Department of Surgery, Division of Urology, King Abdulaziz Medical City and King Saud Bin Abdulaziz University for Health Sciences, Jeddah, Saudi Arabia
- Address for correspondence: Dr. Sultan Alkhateeb, Department of Surgery, Division of Urology, King Abdulaziz Medical City, King Saud bin Abdulaziz University for Health Sciences, P.O. Box: 22490 (1446), Riyadh 11426, Saudi Arabia. E-mail:
| | - Abdullah Alghamdi
- Department of Urology, Prince Sultan Medical Military Center, Jeddah, Saudi Arabia
| | - Khalid Alghamdi
- Department of Surgery, Division of Urology, Security Forces Hospital, Jeddah, Saudi Arabia
| | - Esam Murshid
- Department of Oncology, Oncology Center, Prince Sultan Medical Military City, Jeddah, Saudi Arabia
| | - Ashraf Abusamra
- Department of Surgery, Urology Section, King Khalid Hospital, King Abdulaziz Medical City, Ministry of National Guard Health Affairs, Jeddah, Saudi Arabia
| | - Danny Rabah
- Department of Surgery, College of Medicine and Uro-oncology Research Chair, King Saud University, Jeddah, Saudi Arabia
| | - Imran Ahmad
- Department of Oncology, King Faisal Specialist Hospital and Research Center, Jeddah, Saudi Arabia
| | - Mubarak Al-Mansour
- Department of Oncology, King Abdulaziz Medical City and King Saud Bin Abdulaziz University for Health Sciences, Jeddah, Saudi Arabia
| | - Abdullah Alsharm
- Department of Medical Oncology, Comprehensive Cancer Center, King Fahad Medical City, Riyadh, Saudi Arabia
| |
Collapse
|
12
|
Cook GJ, Sohaib A, Huddart RA, Dearnaley DP, Horwich A, Chua S. The role of 18F-FDG PET/CT in the management of testicular cancers. Nucl Med Commun 2015; 36:702-8. [PMID: 25757201 DOI: 10.1097/mnm.0000000000000303] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVES The aim of this study was to determine the utility of fluorine-18 fluorodeoxyglucose PET/computed tomography ((18)F-FDG PET/CT) in managing testicular cancer. PATIENTS AND METHODS Sixty-two patients (29 seminoma, 28 nonseminoma and five mixed) underwent 75 (18)F-FDG PET/CT scans (16 scans for primary staging, 44 for residual masses and 15 for rising tumour markers). Follow-up histology, clinical scans and tumour marker results were included for retrospective analysis. RESULTS (i) Primary staging: eight of 11 patients with equivocal CT scans had true-negative (18)F-FDG PET/CT scans. Five high-risk patients with normal stage 1 CT scans had negative (18)F-FDG PET/CT scans, but two subsequently relapsed. (ii) Residual masses: of the 20 scans interpreted as showing viable disease, five were false positive. Nineteen scans were negative (18 true negative and one false negative). (iii) Rising tumour markers: of the 15 scans, two were false negative and 13 were true positive. CONCLUSION (18)F-FDG PET/CT is helpful when primary staging CT scans are equivocal but insufficiently sensitive to predict relapse in high-risk patients with normal CT scans. With residual masses, a negative scan is rarely associated with relapse. (18)F-FDG PET/CT is helpful in defining recurrent disease in the majority of patients with rising tumour markers and negative CT scans.
Collapse
Affiliation(s)
- Gary J Cook
- aKings College London bRoyal Marsden NHS Foundation Trust, London cInstitute of Cancer Research, Sutton, Surrey, UK
| | | | | | | | | | | |
Collapse
|
13
|
Mafeld S, Vasdev N, Patel A, Ali T, Lane T, Boustead G, Thorpe AC, Adshead JM, Haslam P. Evolving role of positron emission tomography (PET) in urological malignancy. BJU Int 2015; 116:538-45. [PMID: 25410715 DOI: 10.1111/bju.12988] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
We present a review on the increasing indications for the use of positron emission tomography (PET) in uro-oncology. In this review we describe the details of the different types of PET scans, indications for requesting PET scans in specific urological malignancy and the interpretation of the results.
Collapse
Affiliation(s)
- Sebastian Mafeld
- Department of Radiology, Freeman Hospital, Newcastle upon Tyne, UK
| | - Nikhil Vasdev
- Department of Urology, Freeman Hospital, Newcastle upon Tyne, UK.,Hertfordshire and South Bedfordshire Robotic Urological Cancer Centre, Department of Urology, Lister Hospital, Stevenage, UK
| | - Amit Patel
- Hertfordshire and South Bedfordshire Robotic Urological Cancer Centre, Department of Urology, Lister Hospital, Stevenage, UK
| | - Tamir Ali
- Department of Radiology, Freeman Hospital, Newcastle upon Tyne, UK
| | - Timothy Lane
- Hertfordshire and South Bedfordshire Robotic Urological Cancer Centre, Department of Urology, Lister Hospital, Stevenage, UK
| | - Gregory Boustead
- Hertfordshire and South Bedfordshire Robotic Urological Cancer Centre, Department of Urology, Lister Hospital, Stevenage, UK
| | - Andrew C Thorpe
- Department of Urology, Freeman Hospital, Newcastle upon Tyne, UK
| | - James M Adshead
- Hertfordshire and South Bedfordshire Robotic Urological Cancer Centre, Department of Urology, Lister Hospital, Stevenage, UK
| | - Philip Haslam
- Department of Radiology, Freeman Hospital, Newcastle upon Tyne, UK
| |
Collapse
|
14
|
Abstract
Imaging plays an important role in the clinical management of cancer patients. Hybrid imaging with PET/computed tomography (CT) is having a broad impact in oncology, and in recent years PET/CT is beginning to have an impact in urooncology. In both bladder and renal cancers, there is a need to study the efficacy of other tracers than F-18 fluorodeoxyglucose (FDG), particularly tracers with limited renal excretion. Thus, new tracers are being introduced. This review focuses on the clinical role of FDG and other PET agents in renal, bladder, and testicular cancers.
Collapse
|
15
|
Decoene J, Winter C, Albers P. False-positive fluorodeoxyglucose positron emission tomography results after chemotherapy in patients with metastatic seminoma. Urol Oncol 2015; 33:23.e15-23.e21. [DOI: 10.1016/j.urolonc.2014.09.019] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2014] [Revised: 09/16/2014] [Accepted: 09/30/2014] [Indexed: 10/24/2022]
|
16
|
Tumeurs germinales primitives du médiastin : expérience de l’Institut de cancérologie de Lorraine sur une période de 20 ans (1990-2012). Bull Cancer 2014; 101:1067-73. [DOI: 10.1684/bdc.2014.2047] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
|
17
|
Alotaibi M, Bazarbashi S, Alkhateeb S, Abusamra A, Rabah D, Almansour M, Murshid E, Alsharm A, Ahmad I, Alghamdi K, Saadeddin A, Alghamdi A. Saudi oncology society and Saudi urology association combined clinical management guidelines for testicular germ cell tumors. Urol Ann 2014; 6:290-5. [PMID: 25371603 PMCID: PMC4216532 DOI: 10.4103/0974-7796.140978] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2014] [Accepted: 04/15/2014] [Indexed: 02/05/2023] Open
Abstract
In this report, updated guidelines for the evaluation, medical, and surgical management of germ cell tumor of testes are resented. They are categorized according the stage of the disease using the tumor-node-metastasis staging system 7(th) edition. The recommendations are presented with supporting level of evidence.
Collapse
Affiliation(s)
- Mohammed Alotaibi
- Department of Urology, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
| | - Shouki Bazarbashi
- Oncology center Section of Medical Oncology, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
| | - Sultan Alkhateeb
- Department of Surgery, Division of Urology, Riyadh, Saudi Arabia
| | - Ashraf Abusamra
- Section of Urology, Department of Surgery, King Khaled Hospital, Jeddah, Saudi Arabia
| | - Danny Rabah
- Department of Surgery, Division of Urology, College of Medicine, King Khalid University Hospital, King Saud University, Riyadh, Saudi Arabia
- Princess Al-Johora Al-Ibrahim Centre for Cancer Research (Uro-Oncology Research Chair), King Saud University, Riyadh, Saudi Arabia
- Address for correspondence: Prof. Danny Rabah, Department of Surgery, Division of Urology, College of Medicine, King Khalid University Hospital, Riyadh, Kingdom of Saudi Arabia Princess Al Johora Al Ibrahim Centre for Cancer Research (Uro Oncology Research Chair), King Saud University, Riyadh, Saudi Arabia. E-mail:
| | - Mubarak Almansour
- Oncology department, Princess Noura Oncology Center, King Abdulaziz Medical City, Jeddah, Saudi Arabia
| | - Esam Murshid
- Department of Oncology, Prince Sultan Military Medical City, Riyadh, Saudi Arabia
| | - Abdullah Alsharm
- Department of Oncology, King Fahad Medical City, Riyadh, Saudi Arabia
| | - Imran Ahmad
- Department of Oncology, King Faisal Specialist Hospital and Research Center, Jeddah, Saudi Arabia
| | - Khalid Alghamdi
- Division of Urology, Security Forces Hospital, Riyadh, Saudi Arabia
| | - Ahmad Saadeddin
- Department of Oncology, King Abdulaziz Medical City, Riyadh, Saudi Arabia
| | - Abdullah Alghamdi
- Department of Urology, Prince Sultan Military Medical City, Riyadh, Saudi Arabia
| |
Collapse
|
18
|
Diagnostic performance of fluorine-18-fluorodeoxyglucose positron emission tomography in the postchemotherapy management of patients with seminoma: systematic review and meta-analysis. BIOMED RESEARCH INTERNATIONAL 2014; 2014:852681. [PMID: 24963486 PMCID: PMC4052095 DOI: 10.1155/2014/852681] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/08/2014] [Accepted: 04/11/2014] [Indexed: 12/04/2022]
Abstract
Objective. To meta-analyze published data about the diagnostic performance of fluorine-18-Fluorodeoxyglucose (18F-FDG) positron emission tomography (PET) and PET/computed tomography (PET/CT) in the postchemotherapy management of patients with seminoma. Methods. A comprehensive literature search of studies published through January 2014 on this topic was performed. All retrieved studies were reviewed and qualitatively analyzed. Pooled sensitivity and specificity, positive and negative predictive values (PPV and NPV), accuracy, and area under the summary ROC curve (AUC) of 18F-FDG-PET or PET/CT on a per examination-based analysis were calculated. Subgroup analyses considering the size of residual/recurrent lesions were carried out. Results. Nine studies including 375 scans were selected. The pooled analysis provided the following results: sensitivity 78% (95% confidence interval (95% CI): 67–87%), specificity 86% (95% CI: 81–89%), PPV 58% (95% CI: 48–68%), NPV 94% (95% CI: 90–96%), and accuracy 84% (95% CI: 80–88%). The AUC was 0.90. A better diagnostic accuracy of 18F-FDG-PET or PET/CT in evaluating residual/recurrent lesions >3 cm compared to those <3 cm was found. Conclusions. 18F-FDG-PET and PET/CT were demonstrated to be accurate imaging methods in the postchemotherapy management of patients with seminoma; nevertheless possible sources of false-negative and false-positive results should be considered. The literature focusing on this setting still remains limited and cost-effectiveness analyses are warranted.
Collapse
|
19
|
Positive FDG-PET/CT scans of a residual seminoma after chemotherapy and radiotherapy: case report and review of the literature. Clin Genitourin Cancer 2014; 12:e147-50. [PMID: 24674785 DOI: 10.1016/j.clgc.2014.02.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2013] [Revised: 02/19/2014] [Accepted: 02/24/2014] [Indexed: 11/21/2022]
|
20
|
Stein ME, Drumea K, Charas T, Gershuny A, Ben-Yosef R. Platinum-based Chemotherapy in Primary Advanced Seminoma-a Retrospective Analysis: Treatment Results at the Northern Israel Oncology Center (1989-2010). Rambam Maimonides Med J 2014; 5:e0005. [PMID: 24498512 PMCID: PMC3904480 DOI: 10.5041/rmmj.10139] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVE Over the past 30 years, great strides have been made in the treatment of disseminated testicular tumors. Despite the low number of patients and the rarity of studies concerning primary advanced seminoma, the efficacy of chemotherapy is clear, mainly 3-4-cisplatin-based chemotherapy. Aiming to contribute to the understanding and implementation of proper chemotherapeutic management in advanced seminoma patients, we retrospectively summarized our experience with 26 patients who were referred for platinum-based chemotherapy, post-orchiectomy to the Northern Israel Oncology Center between 1989 and 2010. Response rate, side effects, and long-term outcome were investigated. METHODS Before chemotherapy, meticulous staging was done, including tumor markers (B-human chorionic gonadotropin (B-HCG), alpha-fetoprotein (AFP), and lactic dehydrogenase (LDH)), and abdominal and pelvic computerized tomography (CT) scans were carried out. RESULTS All 26 treated patients achieved complete remission, clinically and symptomatically, with normalization of their CT scans. At a median follow-up of 120 months (range, 24-268 months) all patients are alive, without evidence of recurrent disease. One patient whose disease recurred twice achieved a third complete remission following salvage treatment with high-dose chemotherapy and autologous peripheral stem cell transplantation. Another patient, who preferred surveillance, relapsed abdominally after 9 months but achieved long-standing complete remission with cisplatin-based chemotherapy. Both these patients are alive with no evidence of disease. Three patients recovered uneventfully from bleomycin-induced pneumonitis. CONCLUSIONS Advanced seminoma is a highly curable disease using platinum-based chemotherapy. Our study confirms the efficacy and safety of cisplatin-based chemotherapy in the treatment of advanced seminoma.
Collapse
Affiliation(s)
- Moshe E. Stein
- Northern Israel Oncology Center and Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel and
- To whom correspondence should be addressed. E-mail:
| | - Karen Drumea
- Northern Israel Oncology Center and Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel and
| | - Tomer Charas
- Northern Israel Oncology Center and Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel and
| | - Anthony Gershuny
- Department of Clinical Oncology & Radiation Therapy, Queen’s Hospital, Romford, Essex, UK
| | - Rahamim Ben-Yosef
- Northern Israel Oncology Center and Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel and
| |
Collapse
|
21
|
Isolated femoral muscle and bone metastases rarely encountered in testicular seminoma. Case Rep Oncol Med 2013; 2013:780493. [PMID: 23762691 PMCID: PMC3666421 DOI: 10.1155/2013/780493] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2013] [Accepted: 04/12/2013] [Indexed: 01/07/2023] Open
Abstract
Isolated muscle and bone metastases are rarely encountered in patients with testicular seminomas. In the present study, a patient who was admitted with pain, loss of motion, and swelling in the right leg 20 months following surgery for stage I seminoma was presented. Hypermetabolic lesion was detected in the right femoral muscle and bone via positron emission tomography. After the presence of metastasis from seminoma was confirmed by biopsy, bleomycin, cisplatin, and etoposide, combination chemotherapy was administered to the patient.
Collapse
|
22
|
Wagner M, Bellmunt J, Boutros C, Bonardel G, Loriot Y, Albiges L, Massard C, Fizazi K. False Positive 2-18Fluroro-deoxy-D-Glucose Positron Emission Tomography (FDG-PET) in Patients With Disseminated Seminoma and Post-Chemotherapy Residual Masses. Clin Genitourin Cancer 2013; 11:66-9. [DOI: 10.1016/j.clgc.2012.06.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2012] [Revised: 06/14/2012] [Accepted: 06/15/2012] [Indexed: 11/25/2022]
|
23
|
Siekiera J, Małkowski B, Jóźwicki W, Jasiński M, Wronczewski A, Pietrzak T, Chmielowska E, Petrus A, Kamecki K, Mikołajczak W, Kraśnicki K, Chłosta P, Drewa T. Can We Rely on PET in the Follow-Up of Advanced Seminoma Patients? Urol Int 2012; 88:405-9. [DOI: 10.1159/000337056] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2011] [Accepted: 01/21/2012] [Indexed: 11/19/2022]
|
24
|
Müller J, Schrader M, Schrader A, Höpfner M, Zengerling F. Stellenwert der Positronenemissionstomographie bei urologischen Tumoren. Urologe A 2012; 51:331-40. [DOI: 10.1007/s00120-012-2834-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
|
25
|
Bachner M, Loriot Y, Gross-Goupil M, Zucali PA, Horwich A, Germa-Lluch JR, Kollmannsberger C, Stoiber F, Fléchon A, Oechsle K, Gillessen S, Oldenburg J, Cohn-Cedermark G, Daugaard G, Morelli F, Sella A, Harland S, Kerst M, Gampe J, Dittrich C, Fizazi K, De Santis M. 2-¹⁸fluoro-deoxy-D-glucose positron emission tomography (FDG-PET) for postchemotherapy seminoma residual lesions: a retrospective validation of the SEMPET trial. Ann Oncol 2012; 23:59-64. [PMID: 21460378 DOI: 10.1093/annonc/mdr052] [Citation(s) in RCA: 95] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND 2-¹⁸fluoro-deoxy-D-glucose positron emission tomography (FDG-PET) has been recommended in international guidelines in the evaluation of postchemotherapy seminoma residuals. Our trial was designed to validate these recommendations in a larger group of patients. PATIENTS AND METHODS FDG-PET studies in patients with metastatic seminoma and residual masses after platinum-containing chemotherapy were correlated with either the histology of the resected lesion(s) or the clinical outcome. RESULTS One hundred and seventy seven FDG-PET results were contributed. Of 127 eligible PET studies, 69% were true negative, 11% true positive, 6% false negative, and 15% false positive. We compared PET scans carried out before and after a cut-off level of 6 weeks after the end of the last chemotherapy cycle. PET sensitivity, specificity, negative predictive value (NPV), and positive predictive value were 50%, 77%, 91%, and 25%, respectively, before the cut-off and 82%, 90%, 95%, and 69% after the cut-off. PET accuracy significantly improved from 73% before to 88% after the cut-off (P=0.032). CONCLUSION Our study confirms the high specificity, sensitivity, and NPV of FDG-PET for evaluating postchemotherapy seminoma residuals. When carried out at an adequate time point, FDG-PET remains a valuable tool for clinical decision-making in this clinical setting and spares patients unnecessary therapy.
Collapse
Affiliation(s)
- M Bachner
- ACR-ITR VIEnna/CEADDP, LBI-ACR VIEnna, and KFJ-Spital, Vienna, Austria
| | - Y Loriot
- Institut Gustave Roussy, Villejuif, France
| | | | - P A Zucali
- Istituto Clinico Humanitas IRCCS, Rozzano (Milan), Italian Germ Cell Cancer Group
| | - A Horwich
- The Royal Marsden Hospital, London and Surrey, UK
| | | | | | - F Stoiber
- Krankenhaus der Barmherzigen Schwestern, Linz, Austria
| | | | - K Oechsle
- Universitätsklinikum Hamburg-Eppendorf, Hamburg, Germany
| | - S Gillessen
- Kantonsspital St. Gallen, St. Gallen, Switzerland
| | | | - G Cohn-Cedermark
- Department of Oncology-Pathology, Karolinska Institute and University Hospital, Stockholm, Sweden
| | - G Daugaard
- Department of Oncology, 5073 Rigshospitalet, Copenhagen, Denmark
| | - F Morelli
- Casa Sollievo della Sofferenza, San Giovanni Rotondo, Italy
| | - A Sella
- Assaf Harofeh Medical Center, Zerifin, Israel
| | - S Harland
- University College Hospital London, London, UK
| | - M Kerst
- The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - J Gampe
- Max Planck Institute for Demographic Research, Rostock, Germany
| | - C Dittrich
- ACR-ITR VIEnna/CEADDP, LBI-ACR VIEnna, and KFJ-Spital, Vienna, Austria
| | - K Fizazi
- Institut Gustave Roussy, Villejuif, France
| | - M De Santis
- ACR-ITR VIEnna/CEADDP, LBI-ACR VIEnna, and KFJ-Spital, Vienna, Austria.
| |
Collapse
|
26
|
Müller J, Schrader AJ, Jentzmik F, Schrader M. [Assessment of residual tumours after systemic treatment of metastatic seminoma: ¹⁸F-2-fluoro-2-deoxy-D-glucose positron emission tomography - meta-analysis of diagnostic value]. Urologe A 2011; 50:322-7. [PMID: 21161157 DOI: 10.1007/s00120-010-2469-3] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
BACKGROUND Meta-analysis evaluating the accuracy and sensitivity of FDG (2-[(18)F]-fluoro-2-deoxy-D-glucose) positron emission tomography (PET) to predict viable residual tumours in patients with metastatic seminoma. MATERIAL AND METHODS Altogether 5 studies with 130 patients were identified. Both FDG PET and the size of the residual lesions on conventional computed tomography (CT; lesions either ≤ or > 3 cm) were correlated with the presence or absence of viable residual tumour. RESULTS The specificity (92 vs 59%), sensitivity (72 vs 63%), positive (70 vs 28%) and negative (93 vs 86%) predictive value of FDG PET were superior to data obtained by assessing residual tumour size (either ≤ or > 3 cm) applying CT scans alone. CONCLUSION In view of the data currently available, FDG PET seems to be a clinically useful predictor of viable tumour in post-chemotherapy residuals of pure seminoma.
Collapse
Affiliation(s)
- J Müller
- Klinik für Urologie, Universitätsklinikum Ulm, Pritzwitzstraße 43, 89075 Ulm, Deutschland.
| | | | | | | |
Collapse
|
27
|
Boujelbene N, Prior J, Boubaker A, Azria D, Schaffer M, Gez E, Jichlinski P, Meuwly JY, Mirimanoff R, Ozsahin M, Zouhair A. Intérêt de la tomographie par émission de positons couplée à la scanographie (TEP/TDM) dans les cancers urologiques. Cancer Radiother 2011; 15:307-15. [DOI: 10.1016/j.canrad.2010.12.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2010] [Revised: 11/26/2010] [Accepted: 12/23/2010] [Indexed: 10/18/2022]
|
28
|
Al Otaibi M, El-naghi M, Balaraj K, Bazarbashi S, Rabbah D, Al Othman K, Al Saeed E, Al Ghamdi A, Aljubran A, Murshid E, Al Oraifi I, Al Kushi H. Saudi Oncology Society clinical management guidelines for testicular germ cell tumors. Urol Ann 2011; 3 Suppl:S17-20. [PMID: 21673848 PMCID: PMC3099483 DOI: 10.4103/0974-7796.78551] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
In this report, guidelines for the evaluation, medical and surgical management of testicular germ cell tumors is presented. It is categorized according to the stage of the disease using the tumor node metastasis staging system, 7th edition. The recommendations are presented with supporting level of evidence.
Collapse
Affiliation(s)
- Mohammed Al Otaibi
- Department of Urology, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
- Address for correspondence: Dr. Mohammed Al Otaibi, King Faisal Specialist Hospital and Research Center, POBOX 3354, MBC 83, Riyadh - 11211, Saudi Arabia. E-mail:
| | - Mohammed El-naghi
- Department of Urology, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
| | - Khaled Balaraj
- Department of Urology, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
| | - Shouki Bazarbashi
- Department of Urology, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
| | - Dany Rabbah
- Department of Urology, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
| | - Khaled Al Othman
- Department of Urology, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
| | - Eyad Al Saeed
- Department of Urology, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
| | - Abdullah Al Ghamdi
- Department of Urology, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
| | - Ali Aljubran
- Department of Urology, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
| | - Essam Murshid
- Department of Urology, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
| | - Ibraheem Al Oraifi
- Department of Urology, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
| | - Hussein Al Kushi
- Department of Urology, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
| |
Collapse
|
29
|
Abstract
Testicular cancer is a rare tumor, subdivided into seminomatous and nonseminomatous tumors. Whereas there are no serum tumor markers in the first group, they are present in nonseminomatous tumors, and are also important prognostic factors. Overall, the prognosis for testicular cancers is good, which makes the choice of accurate treatment intensity between under- and overtreatment often difficult. Residual masses in advanced clinical stages occur frequently but are nonvital tissue. PET with F-18 FDG has no defined role in imaging of primary tumors where CT is the first-choice imaging modality. For assessing the success of chemotherapy in the presence of residual masses, especially in pure seminoma, F-18 FDG PET is an important tool. In nonseminomatous tumors, it is hampered by the false-negative results in mature teratoma, for which reason false-negative results are a common problem. F-18 FDG PET performs best in predicting relapse in seminoma residuals larger than 3 cm. So far, no alternative to F-18 FDG for PET imaging of testicular cancer has been found. PET-CT has not yet been proven to be superior to PET alone in testicular cancer.
Collapse
|
30
|
Sterbis JR, Rice KR, Javitt MC, Schenkman NS, Brassell SA. Fusion imaging: a novel staging modality in testis cancer. J Cancer 2010; 1:223-9. [PMID: 21103077 PMCID: PMC2990077 DOI: 10.7150/jca.1.223] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2010] [Accepted: 11/03/2010] [Indexed: 11/30/2022] Open
Abstract
Objective: Computed tomography and chest radiographs provide the standard imaging for staging, treatment, and surveillance of testicular germ cell neoplasms. Positron emission tomography has recently been utilized for staging, but is somewhat limited in its ability to provide anatomic localization. Fusion imaging combines the metabolic information provided by positron emission tomography with the anatomic precision of computed tomography. To the best of our knowledge, this represents the first study of the effectiveness using fusion imaging in evaluation of patients with testis cancer. Methods: A prospective study of 49 patients presenting to Walter Reed Army Medical Center with testicular cancer from 2003 to 2009 was performed. Fusion imaging was compared with conventional imaging, tumor markers, pathologic results, and clinical follow-up. Results: There were 14 true positives, 33 true negatives, 1 false positive, and 1 false negative. Sensitivity, specificity, positive predictive value, and negative predictive value were 93.3, 97.0, 93.3, and 97.0% respectively. In 11 patient scenarios, fusion imaging differed from conventional imaging. Utility was found in superior lesion detection compared to helical computed tomography due to anatomical/functional image co-registration, detection of micrometastasis in lymph nodes (pathologic nodes < 1cm), surveillance for recurrence post-chemotherapy, differentiating fibrosis from active disease in nodes < 2.5cm, and acting as a quality assurance measure to computed tomography alone. Conclusions: In addition to demonstrating a sensitivity and specificity comparable or superior to conventional imaging, fusion imaging shows promise in providing additive data that may assist in clinical decision-making.
Collapse
Affiliation(s)
- Joseph R Sterbis
- 1. Urology Service, Department of Surgery, Walter Reed Army Medical Center, Washington, DC, USA
| | | | | | | | | |
Collapse
|
31
|
Wood L, Kollmannsberger C, Jewett M, Chung P, Hotte S, O'Malley M, Sweet J, Anson-Cartwright L, Winquist E, North S, Tyldesley S, Sturgeon J, Gospodarowicz M, Segal R, Cheng T, Venner P, Moore M, Albers P, Huddart R, Nichols C, Warde P. Canadian consensus guidelines for the management of testicular germ cell cancer. Can Urol Assoc J 2010; 4:e19-38. [PMID: 20368885 PMCID: PMC2845668 DOI: 10.5489/cuaj.815] [Citation(s) in RCA: 91] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Affiliation(s)
- Lori Wood
- Division of Medical Oncology, Queen Elizabeth II Health Sciences Centre, Halifax, NS
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
32
|
Cisplatin-based chemotherapy for advanced seminoma: report of 52 cases treated in two institutions. J Cancer Res Clin Oncol 2009; 135:1495-500. [DOI: 10.1007/s00432-009-0596-2] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2009] [Accepted: 04/22/2009] [Indexed: 11/26/2022]
|
33
|
Oechsle K, Hartmann M, Brenner W, Venz S, Weissbach L, Franzius C, Kliesch S, Mueller S, Krege S, Heicappell R, Bares R, Bokemeyer C, de Wit M. [18F]Fluorodeoxyglucose Positron Emission Tomography in Nonseminomatous Germ Cell Tumors After Chemotherapy: The German Multicenter Positron Emission Tomography Study Group. J Clin Oncol 2008; 26:5930-5. [DOI: 10.1200/jco.2008.17.1157] [Citation(s) in RCA: 132] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Purpose In patients with metastatic nonseminomatous germ cell cancer (NSGCT), residual masses after chemotherapy (CTX) can consist of vital carcinoma, mature teratoma, or necrosis. This prospective trial has evaluated the accuracy of [18F]fluorodeoxyglucose positron emission tomography (FDG-PET) for the prediction of histology compared with computed tomography (CT) and serum tumor markers (STM). Patients and Methods A total of 121 patients with stage IIC or III NSGCT scheduled for secondary resection after cisplatin-based CTX were included. FDG-PET was performed after completion of CTX. All results were confirmed by histopathology and correlated to STM and CT. Results Prediction of tumor viability with FDG-PET was correct in 56%, which did not reach the expected clinically relevant level of 70%, and was not better than the accuracy of CT (55%) or STM (56%). Sensitivity and specificity of FDG-PET were 70% and 48%. The positive predictive values were not significantly different (55%, 61%, and 59% for CT, STM, and PET, respectively). Judging only vital carcinoma as a true malignant finding, the negative predictive value increased to 83% for FDG-PET. Conclusion The presence of vital carcinoma and mature teratoma is common (55%) in residual masses in patients with NSGCT, and CT and STM cannot reliably predict absence of disease. In contrast to prior studies, this prospective trial, which is the only with histologic confirmation in all patients, demonstrated that FDG-PET is unable to give a clear additional clinical benefit to the standard diagnostic procedures, CT and STM, in the prediction of tumor viability in residual masses.
Collapse
Affiliation(s)
- Karin Oechsle
- From the Department of Oncology/Hematology/Pneumology, University Medical Center Eppendorf; Departments of Urology and Nuclear Medicine, University Hospital Hamburg-Eppendorf, Hamburg; Department of Nuclear Medicine, Munich; Euromed, Urology, Fuerth; Department of Nuclear Medicine; Department of Urology, University Hospital Muenster, Muenster; Department of Nuclear Medicine University Hospital Essen, Essen; Department of Urology, Krankenhaus Maria-Hilf GmbH Krefeld, Krefeld; Department of Urology,
| | - Michael Hartmann
- From the Department of Oncology/Hematology/Pneumology, University Medical Center Eppendorf; Departments of Urology and Nuclear Medicine, University Hospital Hamburg-Eppendorf, Hamburg; Department of Nuclear Medicine, Munich; Euromed, Urology, Fuerth; Department of Nuclear Medicine; Department of Urology, University Hospital Muenster, Muenster; Department of Nuclear Medicine University Hospital Essen, Essen; Department of Urology, Krankenhaus Maria-Hilf GmbH Krefeld, Krefeld; Department of Urology,
| | - Winfried Brenner
- From the Department of Oncology/Hematology/Pneumology, University Medical Center Eppendorf; Departments of Urology and Nuclear Medicine, University Hospital Hamburg-Eppendorf, Hamburg; Department of Nuclear Medicine, Munich; Euromed, Urology, Fuerth; Department of Nuclear Medicine; Department of Urology, University Hospital Muenster, Muenster; Department of Nuclear Medicine University Hospital Essen, Essen; Department of Urology, Krankenhaus Maria-Hilf GmbH Krefeld, Krefeld; Department of Urology,
| | - Stephan Venz
- From the Department of Oncology/Hematology/Pneumology, University Medical Center Eppendorf; Departments of Urology and Nuclear Medicine, University Hospital Hamburg-Eppendorf, Hamburg; Department of Nuclear Medicine, Munich; Euromed, Urology, Fuerth; Department of Nuclear Medicine; Department of Urology, University Hospital Muenster, Muenster; Department of Nuclear Medicine University Hospital Essen, Essen; Department of Urology, Krankenhaus Maria-Hilf GmbH Krefeld, Krefeld; Department of Urology,
| | - Lothar Weissbach
- From the Department of Oncology/Hematology/Pneumology, University Medical Center Eppendorf; Departments of Urology and Nuclear Medicine, University Hospital Hamburg-Eppendorf, Hamburg; Department of Nuclear Medicine, Munich; Euromed, Urology, Fuerth; Department of Nuclear Medicine; Department of Urology, University Hospital Muenster, Muenster; Department of Nuclear Medicine University Hospital Essen, Essen; Department of Urology, Krankenhaus Maria-Hilf GmbH Krefeld, Krefeld; Department of Urology,
| | - Christiane Franzius
- From the Department of Oncology/Hematology/Pneumology, University Medical Center Eppendorf; Departments of Urology and Nuclear Medicine, University Hospital Hamburg-Eppendorf, Hamburg; Department of Nuclear Medicine, Munich; Euromed, Urology, Fuerth; Department of Nuclear Medicine; Department of Urology, University Hospital Muenster, Muenster; Department of Nuclear Medicine University Hospital Essen, Essen; Department of Urology, Krankenhaus Maria-Hilf GmbH Krefeld, Krefeld; Department of Urology,
| | - Sabine Kliesch
- From the Department of Oncology/Hematology/Pneumology, University Medical Center Eppendorf; Departments of Urology and Nuclear Medicine, University Hospital Hamburg-Eppendorf, Hamburg; Department of Nuclear Medicine, Munich; Euromed, Urology, Fuerth; Department of Nuclear Medicine; Department of Urology, University Hospital Muenster, Muenster; Department of Nuclear Medicine University Hospital Essen, Essen; Department of Urology, Krankenhaus Maria-Hilf GmbH Krefeld, Krefeld; Department of Urology,
| | - Stephan Mueller
- From the Department of Oncology/Hematology/Pneumology, University Medical Center Eppendorf; Departments of Urology and Nuclear Medicine, University Hospital Hamburg-Eppendorf, Hamburg; Department of Nuclear Medicine, Munich; Euromed, Urology, Fuerth; Department of Nuclear Medicine; Department of Urology, University Hospital Muenster, Muenster; Department of Nuclear Medicine University Hospital Essen, Essen; Department of Urology, Krankenhaus Maria-Hilf GmbH Krefeld, Krefeld; Department of Urology,
| | - Susanne Krege
- From the Department of Oncology/Hematology/Pneumology, University Medical Center Eppendorf; Departments of Urology and Nuclear Medicine, University Hospital Hamburg-Eppendorf, Hamburg; Department of Nuclear Medicine, Munich; Euromed, Urology, Fuerth; Department of Nuclear Medicine; Department of Urology, University Hospital Muenster, Muenster; Department of Nuclear Medicine University Hospital Essen, Essen; Department of Urology, Krankenhaus Maria-Hilf GmbH Krefeld, Krefeld; Department of Urology,
| | - Ruediger Heicappell
- From the Department of Oncology/Hematology/Pneumology, University Medical Center Eppendorf; Departments of Urology and Nuclear Medicine, University Hospital Hamburg-Eppendorf, Hamburg; Department of Nuclear Medicine, Munich; Euromed, Urology, Fuerth; Department of Nuclear Medicine; Department of Urology, University Hospital Muenster, Muenster; Department of Nuclear Medicine University Hospital Essen, Essen; Department of Urology, Krankenhaus Maria-Hilf GmbH Krefeld, Krefeld; Department of Urology,
| | - Roland Bares
- From the Department of Oncology/Hematology/Pneumology, University Medical Center Eppendorf; Departments of Urology and Nuclear Medicine, University Hospital Hamburg-Eppendorf, Hamburg; Department of Nuclear Medicine, Munich; Euromed, Urology, Fuerth; Department of Nuclear Medicine; Department of Urology, University Hospital Muenster, Muenster; Department of Nuclear Medicine University Hospital Essen, Essen; Department of Urology, Krankenhaus Maria-Hilf GmbH Krefeld, Krefeld; Department of Urology,
| | - Carsten Bokemeyer
- From the Department of Oncology/Hematology/Pneumology, University Medical Center Eppendorf; Departments of Urology and Nuclear Medicine, University Hospital Hamburg-Eppendorf, Hamburg; Department of Nuclear Medicine, Munich; Euromed, Urology, Fuerth; Department of Nuclear Medicine; Department of Urology, University Hospital Muenster, Muenster; Department of Nuclear Medicine University Hospital Essen, Essen; Department of Urology, Krankenhaus Maria-Hilf GmbH Krefeld, Krefeld; Department of Urology,
| | - Maike de Wit
- From the Department of Oncology/Hematology/Pneumology, University Medical Center Eppendorf; Departments of Urology and Nuclear Medicine, University Hospital Hamburg-Eppendorf, Hamburg; Department of Nuclear Medicine, Munich; Euromed, Urology, Fuerth; Department of Nuclear Medicine; Department of Urology, University Hospital Muenster, Muenster; Department of Nuclear Medicine University Hospital Essen, Essen; Department of Urology, Krankenhaus Maria-Hilf GmbH Krefeld, Krefeld; Department of Urology,
| |
Collapse
|
34
|
Krege S, Beyer J, Souchon R, Albers P, Albrecht W, Algaba F, Bamberg M, Bodrogi I, Bokemeyer C, Cavallin-Ståhl E, Classen J, Clemm C, Cohn-Cedermark G, Culine S, Daugaard G, De Mulder PH, De Santis M, de Wit M, de Wit R, Derigs HG, Dieckmann KP, Dieing A, Droz JP, Fenner M, Fizazi K, Flechon A, Fosså SD, Garcia del Muro X, Gauler T, Geczi L, Gerl A, Germa-Lluch JR, Gillessen S, Hartmann JT, Hartmann M, Heidenreich A, Hoeltl W, Horwich A, Huddart R, Jewett M, Joffe J, Jones WG, Kisbenedek L, Klepp O, Kliesch S, Koehrmann KU, Kollmannsberger C, Kuczyk M, Laguna P, Leiva Galvis O, Loy V, Mason MD, Mead GM, Mueller R, Nichols C, Nicolai N, Oliver T, Ondrus D, Oosterhof GO, Paz-Ares L, Pizzocaro G, Pont J, Pottek T, Powles T, Rick O, Rosti G, Salvioni R, Scheiderbauer J, Schmelz HU, Schmidberger H, Schmoll HJ, Schrader M, Sedlmayer F, Skakkebaek NE, Sohaib A, Tjulandin S, Warde P, Weinknecht S, Weissbach L, Wittekind C, Winter E, Wood L, von der Maase H. European Consensus Conference on Diagnosis and Treatment of Germ Cell Cancer: A Report of the Second Meeting of the European Germ Cell Cancer Consensus Group (EGCCCG): Part II. Eur Urol 2008; 53:497-513. [PMID: 18191015 DOI: 10.1016/j.eururo.2007.12.025] [Citation(s) in RCA: 190] [Impact Index Per Article: 11.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2007] [Accepted: 12/06/2007] [Indexed: 10/22/2022]
|
35
|
Haba Y, Williams MV, Neal DE, Ong JY, Ostrowski MJ, Ell PJ, Nargund V, Shamash J, Oliver RTD. Stage migration and pilot studies of reduced chemotherapy supported by positron-emission tomography findings suggest new combined strategies for stage 2 nonseminoma germ cell tumour. BJU Int 2008; 101:570-4. [DOI: 10.1111/j.1464-410x.2007.07387.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
|
36
|
Machtens S, Serth J, Meyer A, Kleinhorst C, Ommer KJ, Herbst U, Kieruij M, Boerner AR. Positron emission tomography (PET) in the urooncological evaluation of the small pelvis. World J Urol 2007; 25:341-9. [PMID: 17624533 DOI: 10.1007/s00345-007-0194-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2007] [Accepted: 06/08/2007] [Indexed: 11/29/2022] Open
Abstract
Positron emission tomography (PET) with the use of ((18)F)2-fluoro-D: -2-desoxyglucose (FDG) has been investigated to be a highly sensitive and specific imaging modality in the diagnostic of primary and recurrent tumors and in the control of therapies in numerous non-urologic cancers. The aim of this review is to validate the significance of PET as a diagnostic tool in malignant urological tumors of the small pelvis. A systematic review of the current literature concerning the role of PET for malignant prostate, testicular and bladder tumors was carried out. The data indicate no additional role for PET in comparison with conventional imaging in tumor detection and local staging for prostate, bladder or testicular cancer. Tumor recurrence in prostate cancer seems to be more effectively identified with acetate and choline than with FDG, but this effect is more pronounced with higher PSA values. The value of PET in the identification of metastatic disease in either tumor entity can not be finally outlined as the clinical data are partly missing, controversial or in the process of evaluation. FDG-PET can be regarded as accepted imaging modality in the restaging of seminomatous germ cell tumors after chemotherapy.
Collapse
Affiliation(s)
- S Machtens
- Department of Urology and Paediatric Urology, Marienkrankenhaus Bergisch Gladbach gGmbH, Dr. Robert-Koch-Str. 18, 51465 Bergisch Gladbach, Germany.
| | | | | | | | | | | | | | | |
Collapse
|
37
|
Powles T, Murray I, Brock C, Oliver T, Avril N. Molecular Positron Emission Tomography and PET/CT Imaging in Urological Malignancies. Eur Urol 2007; 51:1511-20; discussion 1520-1. [PMID: 17275167 DOI: 10.1016/j.eururo.2007.01.061] [Citation(s) in RCA: 93] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2006] [Accepted: 01/15/2007] [Indexed: 10/23/2022]
Abstract
OBJECTIVES Positron emission tomography (PET) provides unique insights into molecular pathways of diseases. PET using [F-18]-fluorodeoxyglucose (FDG) has gained increasing acceptance for the diagnosis, staging, and treatment monitoring of various tumour types. The aim of this review is to provide an update on the current status of molecular PET and PET/CT imaging in urological malignancies. METHODS The current literature on PET and PET/CT imaging was reviewed and summarized for prostate cancer, bladder cancer, renal cell carcinoma, and germ cell tumours. RESULTS Depending on the radiotracer used, PET offers diagnostic information based on glucose, choline or amino acid metabolism and has also been applied to imaging tumour cell proliferation and tissue hypoxia in urological malignancies. The diagnostic performance of FDG-PET is hampered by the renal excretion of FDG and by the low metabolic activity often seen in tumours such as prostate cancer. However, new PET tracers including radiolabelled choline and acetate may offer an alternative approach. There is consistent evidence that FDG-PET provides important diagnostic information in detecting metastatic and recurrent germ cell tumours and it might offer additional information in the staging and restaging of bladder and renal cancer. CONCLUSIONS Although PET imaging has been shown to be a clinically useful tool, its application in urological malignancies still needs to be fully determined by larger prospective trials. The introduction of novel PET radiopharmaceuticals along with the new technology of PET/CT will likely change the future role of molecular imaging in urological malignancies.
Collapse
Affiliation(s)
- Tom Powles
- Department of Urology, Barts and the London School of Medicine, Queen Mary, University of London, London, UK
| | | | | | | | | |
Collapse
|
38
|
Ali I, Johns W, Bottger B, Gupta SM. Serendipitous Detection of Testicular Seminoma on F-18 FDG Positron Tomography. Clin Nucl Med 2007; 32:201-2. [PMID: 17314595 DOI: 10.1097/01.rlu.0000255036.41437.e3] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- Iftikhar Ali
- Division of Nuclear Medicine and the Department of Radiology, Danbury Hospital, Danbury, CT, USA
| | | | | | | |
Collapse
|
39
|
Bradford TJ, Montie JE, Hafez KS. The Role of Imaging in the Surveillance of Urologic Malignancies. Urol Clin North Am 2006; 33:377-96. [PMID: 16829272 DOI: 10.1016/j.ucl.2006.03.001] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Urologic malignancies are common, accounting for approximately 25% of all new cancer cases in the United States. Patients with urologic malignancies require long-term surveillance to detect progression or recurrence as early as possible. The urologist is faced with the task of balancing patient safety and cost-effectiveness, while finding the most practical follow-up regimen. For each urologic malignancy, this article reviews the commonly used radiologic techniques for surveillance and offers recommended follow-up schedules.
Collapse
Affiliation(s)
- Timothy J Bradford
- Department of Urology, University of Michigan Medical Center, 1500 East Medical Center Drive, Ann Arbor, MI 48109-0330, USA
| | | | | |
Collapse
|
40
|
Kumar R, Chauhan A. Positron emission tomography: clinical applications in oncology. Part 2. Expert Rev Anticancer Ther 2006; 6:625-40. [PMID: 16613549 DOI: 10.1586/14737140.6.4.625] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
This review continues from a previous review on this topic, which was published in the December issue. In that review, the role of positron emission tomography in lung cancer, lymphoma, breast cancer, head and neck cancer, gastroesophageal cancer, colorectal cancer, malignant melanoma, bone tumors and ovarian cancer was discussed. In this review, the role of positron emission tomography in other malignancies, such as gynecological malignancies other than ovary, pancreatic cancer, hepatocellular cancer, gastrointestinal tumors, urological malignancies, neuroendocrine tumors, adrenocortical tumors, soft-tissue sarcomas, pituitary and brain tumors, is discussed.
Collapse
Affiliation(s)
- Rakesh Kumar
- Department of Nuclear Medicine, All India Institute of Medical Sciences, E-62, Ansari Nagar (East) AIIMS Campus, New Delhi-110029, India.
| | | |
Collapse
|
41
|
Gilligan T. Republication of SEMPET trial data? Eur J Radiol 2006; 58:317; author reply 318. [PMID: 16427235 DOI: 10.1016/j.ejrad.2005.12.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2005] [Accepted: 12/20/2005] [Indexed: 11/18/2022]
Abstract
Becherer and colleagues' report in the European Journal of Radiology of their interesting data on the use of FDG PET in the evaluation of residual masses in seminoma patients is extremely similar to the data that the same authors published in 2004 in the Journal of Clinical Oncology. It would be very helpful to know whether these are the same patients being presented again or a new multicenter study of the same size asking the same question. Oddly, the authors do not acknowledge their prior report even though it was published the same month that the report to the European Journal of Radiology was submitted for review. It would be helpful if the authors explained what the 2005 report adds to the 2004 report for those of us trying to assess the role of FDG PET in this patient population. At this point in time, it appears that there are two studies that have been completed, including a negative trial from the United States and a positive trial (now published three times) from Europe.
Collapse
|
42
|
|
43
|
Quek ML, Simma-Chiang V, Stein JP, Pinski J, Quinn DI, Skinner DG. Postchemotherapy residual masses in advanced seminoma: current management and outcomes. Expert Rev Anticancer Ther 2006; 5:869-74. [PMID: 16221056 DOI: 10.1586/14737140.5.5.869] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Although pure testicular seminoma is most often confined to the testis, it can present with advanced-stage bulky retroperitoneal metastases in nearly a quarter of cases. While highly treatable with cisplatin-based chemotherapy, up to 80% of patients with advanced disease are found to have a radiographically detectable residual mass after chemotherapy. The management of these postchemotherapy residual masses remains controversial. Surgical resection is technically challenging due to a desmoplastic reaction resulting from seminoma treatment and regression. In addition, these residual masses often demonstrate a protracted period of regression that can span several months to years. Surveillance protocols, therefore, may be appropriate for most patients. Several retrospective studies have supported surgical resection only for discrete, well-delineated masses over 3 cm in size. Despite the highly radiosensitive nature of seminoma, radiation therapy in this setting has not been shown to provide significant benefit, and may limit the tolerability of subsequent salvage chemotherapy. The incorporation of noninvasive imaging modalities, such as positron emission tomography, into the management algorithm may better delineate the presence of viable residual tumor and thus allow better risk stratification.
Collapse
Affiliation(s)
- Marcus L Quek
- Department of Urology, Loyola University Stritch School of Medicine, IL 60153, USA.
| | | | | | | | | | | |
Collapse
|
44
|
Abstract
During the last decade, there has been a significant advancement in imaging of urologic diseases. Transrectal ultrasound (TRUS), computerized tomography (CT), magnetic resonance imaging (MRI), magnetic resonance spectroscopy (MRS), and positron emission tomography (PET) are still experiencing new developments in urology. Despite these many technological advances, the initial diagnostic procedure for a patient with suspected prostate cancer (PC) is multiple site blind prostate biopsies. There is a need for a noninvasive metabolic imaging modality to direct the site of biopsy to decrease the sampling error. MRS seems promising but as it is a costly and more time-consuming test, further studies are needed to evaluate its clinical utility. Currently, PET does not play any role to direct biopsy. Acetate and choline appear to be better tracers than FDG for the detection of a prostate lesion, however, further well-organized studies are needed before any of these agents can be used clinically. Incidental detection of intense focal uptake in the prostate during whole body PET scanning should be evaluated with prostate-specific antigen (PSA) and TRUS-guided biopsy. Although FDG is inferior to other tracers for primary staging, it may be useful in selected patients with suspected high-grade cancer. The role of ProstaScint scan is still controversial for detection of recurrent PC. This study may be helpful for evaluating nodal metastases when PSA is elevated and bone scan is negative. Bone scan remains the study of choice when bone metastases are suspected (PSA>15-20 ng/mL+/-bone pain). Acetate and choline provide better accuracy than FDG in the detection of local soft tissue disease, nodal involvement, and distant metastases. High FDG uptake may be indicative of more aggressive and possibly androgen-independent disease. PET/CT with any of the above PET tracers will most likely be preferred to the PET scan alone due to better localization of a hot lesion in PET/CT. Nuclear medicine studies also have been used to evaluate acute scrotum and testicular neoplasms. Scrotal scintigraphy has lost its popularity to Doppler ultrasound in the evaluation of the acute scrotum. In testicular tumors, FDG-PET appears to be superior to conventional imaging modalities in initial staging, detection of residual/recurrence, and monitoring treatment response. Tumor markers after treatment occasionally are elevated and cannot locate the site of recurrence, FDG-PET can play a very important role in this regard. Nuclear medicine studies also have been used to evaluate diseases of the urinary bladder. Radionuclide cystography is more sensitive and has less than 1/20 the radiation exposure of the conventional contrast enhanced micturating cystourethrogram (MCU). However, the utility of FDG-PET in the evaluation of bladder cancer seems to be limited to the evaluation of distant metastases. 11C-Methionine and choline may be a better option for local and nodal disease due to their negligible excretion in the urine.
Collapse
Affiliation(s)
- Suman Jana
- Montefiore Medical Center and Albert Einstein College of Medicine, Bronx, NY 10461, USA
| | | |
Collapse
|
45
|
Krege S, Rübben H. [Lymphadenectomy for testicular cancer. Diagnostic and prognostic significance as well as therapeutic benefit]. Urologe A 2005; 44:652-6. [PMID: 15905990 DOI: 10.1007/s00120-005-0824-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
The rationale to perform retroperitoneal lymph node dissection (RPLND) in testicular cancer depends on the clinical stage and previous therapy. Thus, it can be performed either with diagnostic, prognostic, or therapeutic intention. In verified clinical stage I nonseminoma, RPLND provides one of three adjuvant options. To verify the clinical stage pathologically, surgery is done for diagnostic reasons, since CT scanning provides a false-negative staging in up to 30%. In higher stage lesions RPLND is a therapeutic procedure. The importance, however, of RPLND in clinical stage I nonseminoma is decreasing, since prognostic factors are available to stratify patients with either low or high risk for recurrence. Thus, these patients are selected for surveillance (low risk) or adjuvant chemotherapy (high risk). RPLND after chemotherapy is done for resection of residual tumor with a therapeutic intention. The histology of the residual mass is of prognostic importance and may help define further therapy. Resection of retroperitoneal metastases in patients with chemorefractory tumors is curative in about 25%.
Collapse
Affiliation(s)
- S Krege
- Urologische Klinik, Universitätsklinikum Essen.
| | | |
Collapse
|
46
|
De Giorgi U, Pupi A, Fiorentini G, Rosti G, Marangolo M. FDG-PET in the management of germ cell tumor. Ann Oncol 2005; 16 Suppl 4:iv90-94. [PMID: 15923438 DOI: 10.1093/annonc/mdi915] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Germ cell tumor is the most common malignancy in young men. The cure rate of these patients has tremendously increased in the cisplatin era, and recent results have indicated that the management of patients with GCT is still improving. The use of FDG-PET in the management of patients with GCT has been recently investigated. This report attempts to comprehensively review new advances and delineate the potential applications of FDG-PET in GCT.
Collapse
Affiliation(s)
- U De Giorgi
- Istituto Toscano Tumori, Department of Oncology, San Giuseppe Hospital, Empoli Florence, Italy.
| | | | | | | | | |
Collapse
|
47
|
Becherer A, De Santis M, Karanikas G, Szabó M, Bokemeyer C, Dohmen BM, Pont J, Dudczak R, Dittrich C, Kletter K. FDG PET is superior to CT in the prediction of viable tumour in post-chemotherapy seminoma residuals. Eur J Radiol 2005; 54:284-8. [PMID: 15837411 DOI: 10.1016/j.ejrad.2004.07.012] [Citation(s) in RCA: 104] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2004] [Revised: 07/16/2004] [Accepted: 07/20/2004] [Indexed: 11/19/2022]
Abstract
AIM In advanced seminoma the management of residuals after completion of chemotherapy is controversial. Some centres routinely perform surgery for lesions > or =3 cm diameter, others recommend surgery solely if the residual fail to shrink or show even growth. This study prospectively investigates whether FDG PET can improve the prediction of viable tumour in post-chemotherapy seminoma residuals. MATERIALS AND METHODS After an expansion of a previous study population, 54 patients from eight centres with metastatic seminoma and a CT-documented mass after chemotherapy were included in the study. Six patients were excluded from evaluation because of protocol violations. After PET, the patients underwent either surgery or were followed clinically. On follow-up the lesions were considered to be non-viable when there was unequivocal shrinking, or when the lesion remained morphologically stable for at least 24 months. Any lesion growth was assumed to be malignant. PET results were compared to CT discrimination (< or > or =3 cm) of the residual masses. RESULTS Fifty-two PET scans were evaluable. After adequate chemotherapy, there were 74 CT-documented residual masses ranging in size from 1 to 11 cm (median, 2.2 cm). Their dignities were confirmed histologically in 13 lesions, or by follow-up CT in 61 lesions. Four of forty-seven lesions <3 cm and 11/27 lesions > or =3 cm were viable. PET was true positive in one lesion <3 cm and in 11 lesions > or =3 cm, false negative in three lesions <3 cm, and true negative in 59 lesions (43 lesions <3 cm). No PET scan was false positive. In detecting viability the sensitivity and specificity was 73% (95% CI, 44-88), and 73% (59-83), respectively, for CT (< or > or =3 cm); and 80% (51-95), and 100% (93-100), respectively, for PET (specificity, P < 0.001). CONCLUSION In post-chemotherapy seminoma residuals, a positive PET is highly predictive for the presence of viable tumour. The specificity of PET is significantly higher than that of CT when using a > or =3 cm cut-off. A negative PET scan is excellent for the exclusion of disease in lesions > or =3 cm, with a somewhat higher sensitivity than CT (n.s.). PET can contribute to the management of residual seminoma lesions, especially in terms of avoiding unnecessary additional treatment for patients with lesions > or =3 cm.
Collapse
Affiliation(s)
- Alexander Becherer
- Department of Nuclear Medicine, Ludwig Boltzmann Institute for Nuclear Medicine, University of Vienna, Währinger Gürtel 18-20, Vienna A-1090, Austria.
| | | | | | | | | | | | | | | | | | | |
Collapse
|
48
|
Ruiz Hernández G, Romero de Avila Y Avalos C, Carreras Delgado JL. [The value of 18F-fluoro-2-deoxy-D-glucose positron emission tomography (18F-FDG PET) in diagnosis of neoplastic diseases]. Med Clin (Barc) 2005; 124:229-36. [PMID: 15737307 DOI: 10.1157/13071769] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Positron emission tomography (PET) has the ability to detect cancer based on molecular and biochemical processes within the tumor tissues. The most widely used radiotracer in oncology at this time is the glucose analogue 18F-fluoro-2-deoxy-D-glucose (18F-FDG). Like glucose, 18F-FDG is transported into cells by a glucose transporter protein and rapidly converted into 18F-FDG-6-phosphate. PET imaging with 18F-FDG is able to diagnose, stage, and restage many cancers with accuracies ranging from 80% to 90%. Responses to therapy can be identified earlier and with greater accuracy than is possible with anatomic imaging modalities. The prognostic information available through 18F-FDG PET is superior to that of conventional imaging for many cancers. The aim of this review article is to show the most promising clinical indications for the use of PET in oncology.
Collapse
|
49
|
Abstract
Positron emission tomography (PET) in uro-oncology has been one of the slowest areas to develop. There are problems because of the excretion of tracer through the renal tract. Its use in prostate cancer has generally being disappointing, with PET being unable to differentiate malignancy from benign prostatic hypertrophy. In more advanced disease and in the search for the site of recurrence, PET can be of more use. Also, new tracers may prove to be more effective. PET has been shown to be of value in testicular cancer, particularly in defining recurrent disease in residual masses and in patients with raised markers. There is a clear place for PET in some of these cases. Early studies at staging are promising but more work is required to define its exact place. In renal and bladder cancer, PET may be a useful adjunct to conventional imaging in difficult cases and may assist in local staging. In all tumours it is valuable to differentiate fibrosis from recurrent disease in the treatment bed, an area of difficulty for CT/MR.
Collapse
Affiliation(s)
- S F Hain
- Department of Nuclear Medicine, Charing Cross Hospital, London, UK.
| |
Collapse
|
50
|
Johns Putra L, Putra LJ, Lawrentschuk N, Ballok Z, Hannah A, Poon A, Tauro A, Davis ID, Hicks RJ, Bolton DM, Scott AM. 18F-fluorodeoxyglucose positron emission tomography in evaluation of germ cell tumor after chemotherapy. Urology 2004; 64:1202-7. [PMID: 15596197 DOI: 10.1016/j.urology.2004.07.024] [Citation(s) in RCA: 35] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2004] [Accepted: 07/22/2004] [Indexed: 11/28/2022]
Abstract
OBJECTIVES To evaluate the role of 18F-fluorodeoxyglucose (18F-FDG) positron emission tomography (PET) in the assessment of germ cell tumors after chemotherapy. METHODS We reviewed patients' records for the histologic findings and clinical outcome. 18F-FDG PET results were correlated with tissue histologic features where available; and if not available, the correlation was with the clinical outcome. RESULTS A total of 45 PET studies were performed on 38 patients (age range 19 to 64 years, median 31). All patients had received chemotherapy. In the nonseminomatous germ cell tumor (NSGCT) group, of the 31 patients with one scan, 18 PET scans were reported as positive, with only 2 not having active disease. Of the 12 negative scans, 6 showed teratoma, 1 tumor, and 5 did not show active disease. The equivocal scan revealed thyroid adenoma. In the seminoma group, the PET scans correlated well with the clinical and histologic outcomes. Four patients underwent salvage chemotherapy, and in this subgroup, the PET findings also correlated with the outcome. CONCLUSIONS (18)F-FDG PET is a promising tool as an adjunct to current imaging techniques in detecting residual viable germ cell tumor after chemotherapy. In NSGCT, a positive PET scan was accurate in 16 of 18 patients, although negative PET studies did not exclude the presence of disease, mainly because of the presence of teratoma. In seminoma, a negative 18F-FDG PET study correlated with a favorable clinical outcome. PET was also predictive of the response to salvage chemotherapy and was highly specific for active tumor in both NSGCT and seminoma.
Collapse
Affiliation(s)
- L Johns Putra
- Department of Surgery, University of Melbourne, Melbourne, Australia
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|