Can We Rely on PET in the Follow-Up of Advanced Seminoma Patients?

Abstract

The management of residuals after completion of chemotherapy in advanced seminoma is controversial. It has been proposed that fluorodeoxyglucose-positron emission tomography (FDG-PET) can be used as a follow-up. In this study we investigated FDG-PET as a follow-up tool in advanced seminoma patients treated previously with chemotherapy or radiotherapy. Thirty-seven patients assigned to an advanced seminoma group based on CT and/or FDG-PET/CT and then treated with chemotherapy were included in the study. All these patients underwent FDG-PET/CT examination as a part of the follow-up scheme. Patients underwent retroperitoneal lymph node dissection (RPLND), radiotherapy, or were followed clinically by CT and/or PET/CT every 6 months. In 8 cases FDG-PET was positive: 5 of them underwent RPLND and 3 radiotherapy. Two patients with negative FDG-PET but positive CT also underwent RPLND. The remaining patients with negative FDG-PET results were followed up. FDG-PET/CT was false positive in one case >3 cm and one <3 cm, in 6 cases >3 cm it was true negative. While FDG-PET can find a viable tumor, there also is an important question of false positive results. It was clinically proven that a negative FDG-PET was correlated with stable disease, but we were unable to examine specimens in these cases.

Diagnostic Performance of Fluorine-18-Fluorodeoxyglucose Positron Emission Tomography in the Postchemotherapy Management of Patients with Seminoma: Systematic Review and Meta-Analysis

“…About the study design, three of these studies were prospective [9, 11, 14], 5 were retrospective [6–8, 10, 13], and in one article this information was not provided [12]. Three studies were multicentric [7, 9, 11], whereas six were monocentric [6, 8, 10, 12–14]. Most of the patients performed 18 F-FDG-PET or PET/CT for evaluating abdominal residual lesions at CT imaging after chemotherapy (Table 1).…”

“…Two studies used hybrid PET/CT [6, 8], whereas seven studies used PET only [7, 9–14]. Heterogeneous technical aspects between the included studies were found (Table 2).…”

“…As a matter of fact, no significant heterogeneity among the studies included in the different subgroup analyses was found. Unfortunately, there were insufficient data to perform subgroup analyses taking into account the different device used (PET/CT versus PET) because only two studies assessed the diagnostic performance of 18 F-FDG-PET/CT [6, 8]. Nevertheless, a superior diagnostic performance of PET/CT compared to PET alone is expected.…”

Seminoma Clinical Stage 1 - Patterns of Care in Germany

“…After inguinal orchiectomy, 3 options for CS1 seminoma patients are available. Traditionally, abdominal radiotherapy was the preferred option because microscopic metastatic spread to the retroperitoneal lymph nodes and may be present despite normal imaging results [6,7,8,9]. Although radiotherapy produces excellent durable cure rates, this management strategy was challenged due to rising concerns over possible long-term toxicities as the induction of second malignancies [10].…”

Diagnostic Accuracy of 18F-FDG-PET in Patients with Testicular Cancer: a Meta-analysis

“…Ultimately, 21 studies were excluded for undesirable article types (n=21), not written in English (n=6), and insufficient data (n=4), letter (n=2), case report (n=1), and review (n=8). Thus, 16 studies were included in our final dataset for the meta-analysis (Cremerius et al, 1998;Albers et al, 1999;Cremerius et al, 1999;Hain et al, 2000;Bokemeyer et al, 2002;Spermon et al, 2002;Tsatalpas et al, 2002;Lassen et al, 2003;De Santis et al, 2004;Becherer et al, 2005;de Wit et al, 2008;Hinz et al, 2008;Oechsle et al, 2008;Akbulut et al, 2011;Bachner et al, 2012;Siekiera et al, 2012). The flowchart of study selection was shown in Figure 1.…”