[<sup>18</sup>F]Fluorodeoxyglucose Positron Emission Tomography in Nonseminomatous Germ Cell Tumors After Chemotherapy: The German Multicenter Positron Emission Tomography Study Group

Oechsle, Karin; Hartmann, Michael; Brenner, Winfried; Venz, Stephan; Weißbach, L.; Franzius, Christiane; Kliesch, Sabine; Mueller, Stephan; Krege, Susanne; Heicappell, R.; Bares, Roland; Bokemeyer, Carsten; Wit, Maike de

doi:10.1200/jco.2008.17.1157

Cited by 147 publications

(60 citation statements)

References 32 publications

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“…However, FDG-PET does not offer any benefit over CT in primary staging performed with the intention of discriminating the nature of the residual masses. Although a positive PET scan is highly suggestive of residual viable cancer, false-negative rates of up to 40% have been reported in a prospective trial by Oechsle et al [12] In contrary, PET scan has more utility in patients with disseminated seminoma treated with chemotherapy where it has a higher sensitivity and specificity for the determination of residual viable disease. [13] Although the germ cell tumor is highly responsive to chemotherapy, the success rate of chemotherapy is lower after failure of the first-line chemotherapy.…”

Section: Discussionmentioning

confidence: 98%

Clinico-pathological outcomes of post- primary and salvage chemotherapy retroperitoneal lymph node dissection for mixed germ cell tumors, King Hussein Cancer Center experience

Alqasem

Abukhiran

Jasser

et al. 2016

Turkish Journal of Urology

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Objective: We sought to characterize clinical and pathologic outcomes of advanced mixed germ cell tumors after retroperitoneal lymph node dissection for post-chemotherapy residual masses. Material and methods:Between January 2006 and November 2015, 56 patients underwent retroperitoneal lymph node dissection (RPLND) for residual masses of greater than 1 cm after receiving either primary chemotherapy or salvage chemotherapy. Retrospective review of the patients' characteristics, clinical, pathological, and treatment outcomes were performed after institutional review board (IRB) and ethics committee approval. Results:The mean age at diagnosis was 30 years. Ninety percent of the patients received 3-4 cycles of BEP (bleomycin/etoposide/cisplatin) as primary chemotherapy, and 29% of them salvage chemotherapy prior to lymph node dissection. The mean size of the residual masses after chemotherapy was 6 cm. The histological findings were necrosis in 30%, viable tumor in 34% and teratoma in 36% of the retroperitoneal masses. The mean time to relapse after RPLND was 11 months, out of 9 relapses, 6 were in the retroperitoneum, 1 in the lung and 1 in the kidney and 1 in the contralateral testicle. Conclusion:Our results indicated higher incidence of viable germ cell tumor in the retroperitoneal residual masses after primary and salvage chemotherapy when compared with previously reported global incidence rates.

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Section: Discussionmentioning

confidence: 98%

Clinico-pathological outcomes of post- primary and salvage chemotherapy retroperitoneal lymph node dissection for mixed germ cell tumors, King Hussein Cancer Center experience

Alqasem

Abukhiran

Jasser

et al. 2016

Turkish Journal of Urology

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“…In studies investigating the live tumor presence by PET-CT 70% sensitivity, 48% specificity, 59% positive predictive value and 51% negative predictive value was obtained. PET-CT revealed no uptake in patients with teratoma (18). While there are studies arguing that low attenuation levels in CT predict necrosis, but there are also other studies that don't support this idea (10,19,20).…”

Section: Discussionmentioning

confidence: 98%

Retrospective Analysis of Postchemotheraphy Retroperitoneal Lymph Node Dissection (PC-RPLND) Results in Patients with Non-Seminomatous Testicular Cancers

Soydan¹,

Malkoç²,

Okçelik³

et al. 2015

jus

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ÖZET objectiveResection of residual masses after chemoteraphy in patients with nonseminomatous testicular cancer is recommended. In our study, we evaluated the patients' data underwent post chemotherapy retroperitoneal lymph node dissection (PC-RPLND). Materials and MethodsPatients with advanced staged tumors and Non-seminomatous germ cells and having residual mass after chemotherapy whose tumor markers returned to normal were selected in the study. Pre-chemotherapy mass size, postchemoterapy mass size, decrease rate in the mass size, prognostic factors of local tumor, International Germ Cell Collaborative Clasification (IGCCC) risk groups, and teratoma existence in primary pathology, PC-RPLND pathologies were compared for fibrozis, teratoma or viable tumor presence. In addition, patients with and without intraoperative complications were compared in terms of the same parameters. Comparisons were conducted using Statistical Packages for the Social Sciences (SPSS) 16.0 and p<0.05 was considered statistically significant. amaçNonseminomatöz testis tümörlü hastalarda kemoterapi sonrasında artık kitlelerin çıkarılması önerilmektedir. Çalışmamızda Post Kemoterapi Retroperitoneal Lenf Nodu Diseksiyonu (PK-RPLND) yaptığımız hastalarımızın verilerini değerlendirdik. gereç ve yöntemNonseminomatöz germ hücreli ileri evre tümörlü hastalardan kemoterapi sonrasında artık kitlesi kalıp, tümör belirteçleri normale dönen hastalar çalışmaya alındı. Kemoterapi öncesindeki kitle boyutu, kemoterapi sonrasındaki kitle boyutu, kitledeki küçülme oranı, lokal tümöre ait prognostik faktörler, IGCCC risk grupları ve primer tümörde teratom olup olmamasına göre PK-RPLND patolojileri fibrozis, terotom ve canlı tümör varlığı bakımından karşılaştırıldı. Ayrıca intraoperatif komplikasyon gelişen ve gelişmeyen hastalar da aynı parametreler bakımından karşılaştırıldı. Karşılaştırma Statistical Packages fort he Social Sciences (SPSS) 16.0 kullanılarak yapıldı ve p<0,05 anlamlı olarak kabul edildi.Percentage of reduction in mass size, presence of teratom or not in primary tumor and IGCCC risk groups,also local prognostic factors of primary tumor are not predictable of PC-RPLND pathologies.

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“…The authors of several investigations agree that 18 F-FDG PET predicts viable residual tumor with high diagnostic accuracy, except in small residuals. However, 18 F-FDG PET failed to differentiate mature teratoma from necrosis or fibrosis because both accumulate little or no 18 F-FDG (7,9,11,33). Therefore 18 F-FDG PETnegative residual tumors still require surgical resection.…”

Section: Discussionmentioning

confidence: 99%

“…Several studies assessing the role of 18 F-FDG PET in seminomas found a significant advantage of this modality over CT in evaluating postchemotherapy residues. However, the role of 18 F-FDG PET in staging nonseminomatous residues is limited because 18 F-FDG PET cannot differentiate mature teratoma from necrosis and fibrosis (6,7,(9)(10)(11)(12). In predicting early therapy response, 18 F-FDG PET may have a role in poorprognosis GCT patients, as has been addressed in a pilot study with 19 patients (13,14).…”

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confidence: 99%

PET/CT with ¹⁸F-FLT: Does It Improve the Therapeutic Management of Metastatic Germ Cell Tumors?

Pfannenberg

Aschoff²,

Dittmann³

et al. 2010

J Nucl Med

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Because 18 F-FDG PET alone has only limited value in metastatic germ cell tumors (GCTs), we investigated the addition of 39-deoxy-39-18 F-fluorothymidine (FLT) to 18 F-FDG for early response monitoring and prediction of the histology of residual tumor masses in patients with metastatic GCT. Methods: Eleven patients with metastatic GCT were examined with both 18 F-FDG PET/CT and 18 F-FLT PET/CT before chemotherapy, after the first cycle of chemotherapy (early response), and 3 wk after completion of chemotherapy. In 1 patient with negative 18 F-FLT PET/CT results before chemotherapy, no further 18 F-FLT scanning was performed. PET images were analyzed visually and, using standardized uptake values (SUVs), semiquantitatively. The results were compared with the findings of CT and tumor marker levels and validated by histopathologic examination of resected residual masses, including Ki-67 immunostaining (7 patients), or by clinicoradiologic follow-up for at least 6 mo (4 patients). A responder was defined as a patient showing the presence of necrosis, a complete remission, or a marker-negative partial remission within a minimum progression-free interval of 6 mo. Early treatment response was judged according to the criteria of the European Organization for Research and Treatment of Cancer. Results: Before chemotherapy, reference lesions showed increased 18 F-FDG uptake (mean SUV, 8.8; range, 2.9-15.0) in all patients and moderate 18 F-FLT uptake (mean SUV, 3.7; range, 1.7-9.7) in 10 of 11 patients. After 1 cycle of chemotherapy, mean SUV decreased in responders and nonresponders by 64% and 60%, respectively, for 18 F-FDG (P 5 0.8) and by 58% and 48%, respectively, for 18 F-FLT (P 5 0.5). After the end of chemotherapy, mean SUV decreased in responders and nonresponders by 85% and 73%, respectively, for 18 F-FDG (P 5 0.1) and by 68% and 65%, respectively, for 18 F-FLT (P 5 0.8). The results of early and final PET were inconsistent in 6 of 11 patients for 18 F-FDG and in 4 of 10 patients for 18 F-FLT. Both patients with teratoma had false-negative results on both 18 F-FDG and 18 F-FLT. The sensitivity, specificity, positive predictive value, and negative predictive value for detection of viable tumor after 1 cycle of chemotherapy were 60%, 33%, 43%, and 50%, respectively, for 18 F-FDG and 60%, 80%, 75%, and 67%, respectively, for 18 F-FLT PET/CT. The respective values after the end of chemotherapy were 20%, 100%, 100%, and 60% for 18 F-FDG and 0%, 100%, 0%, and 50% for 18 F-FLT PET/CT. Conclusion: PET-negative residual masses after chemotherapy of metastatic GCT still require resection, since the low negative predictive value of 18 F-FDG PET for viable tumor cannot be improved by application of 18 F-FLT.

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[¹⁸F]Fluorodeoxyglucose Positron Emission Tomography in Nonseminomatous Germ Cell Tumors After Chemotherapy: The German Multicenter Positron Emission Tomography Study Group

Cited by 147 publications

References 32 publications

Clinico-pathological outcomes of post- primary and salvage chemotherapy retroperitoneal lymph node dissection for mixed germ cell tumors, King Hussein Cancer Center experience

Clinico-pathological outcomes of post- primary and salvage chemotherapy retroperitoneal lymph node dissection for mixed germ cell tumors, King Hussein Cancer Center experience

Retrospective Analysis of Postchemotheraphy Retroperitoneal Lymph Node Dissection (PC-RPLND) Results in Patients with Non-Seminomatous Testicular Cancers

PET/CT with ¹⁸F-FLT: Does It Improve the Therapeutic Management of Metastatic Germ Cell Tumors?

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[18F]Fluorodeoxyglucose Positron Emission Tomography in Nonseminomatous Germ Cell Tumors After Chemotherapy: The German Multicenter Positron Emission Tomography Study Group

Cited by 147 publications

References 32 publications

Clinico-pathological outcomes of post- primary and salvage chemotherapy retroperitoneal lymph node dissection for mixed germ cell tumors, King Hussein Cancer Center experience

Clinico-pathological outcomes of post- primary and salvage chemotherapy retroperitoneal lymph node dissection for mixed germ cell tumors, King Hussein Cancer Center experience

Retrospective Analysis of Postchemotheraphy Retroperitoneal Lymph Node Dissection (PC-RPLND) Results in Patients with Non-Seminomatous Testicular Cancers

PET/CT with 18F-FLT: Does It Improve the Therapeutic Management of Metastatic Germ Cell Tumors?

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[¹⁸F]Fluorodeoxyglucose Positron Emission Tomography in Nonseminomatous Germ Cell Tumors After Chemotherapy: The German Multicenter Positron Emission Tomography Study Group

PET/CT with ¹⁸F-FLT: Does It Improve the Therapeutic Management of Metastatic Germ Cell Tumors?