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DOI: 10.1055/s-0041-1735480
End-of-Treatment FDG PET-CT (EOT-PET) in Patients with Post-Chemotherapy Masses for Seminoma: Can We Avoid Further Intervention?
Funding None.
Abstract
Context Patients with seminoma present with advanced disease. End-of-treatment (EOT) positron emission tomography-computed tomography (PET-CT) is done to assess response and direct management of post-chemotherapy residual masses.
Purpose This article assesses the utility of EOT PET-CT in the management of post-chemotherapy residual lymph nodal masses seminoma.
Materials and Methods We analyzed all patients with seminoma who underwent an EOT PET-CT from January 2015 to January 2020 at our center and calculated the positive predictive value (PPV) and negative predictive value (NPV) of EOT PET-CT in the entire cohort of patients and among subgroups.
Results A total of 34 male patients underwent EOT PET-CT. Fourteen (41.2%) were stratified as good risk and 20 (58.8%) as intermediate risk. The median follow-up was 23 months (interquartile range: 9.75–53 months). In 23 patients there were residual masses of size more than 3 cm at the EOT PET scan. EOT PET was positive as per the SEMPET criteria in 18 (78%) out of 23 patients. None underwent retroperitoneal lymph node dissection. All four who underwent image-guided biopsy, showed only necrosis on pathology. One patient with positive mediastinal node (standardized uptake value 13.6) had granulomatous inflammation. There was no relapse or progression during this period of follow-up. The NPV for EOT PET-CT for the entire cohort, > 3 cm, and > 6 weeks cutoff were 100%, respectively. The PPV for EOT PET-CT for the entire cohort, > 3 cm residual mass, and > 6 weeks cutoff were 8.7, 11.11, and 6.67%, respectively.
Conclusion EOT PET-CT has a low PPV and high NPV in predicting viable tumor in post-chemotherapy residual masses among patients with seminomatous germ cell tumors. If required, EOT PET positivity can be confirmed by a biopsy or reassessed with a repeat PET-CT imaging to document persistent disease prior to further intervention.
Authors' Contributions
Anjana Joel: Conceptualization, methodology, formal analysis, investigation, writing - original draft, and visualization.
Ashish Singh: Conceptualization, methodology, formal analysis, investigation, writing - review and editing, visualization, and supervision.
Julie Hepzibah: Conceptualization, methodology, formal analysis, investigation, writing - review and editing, visualization, project administration, and funding acquisition.
Antony Devasia: Conceptualization, methodology, formal analysis, investigation, writing - review and editing, visualization, and supervision.
Santosh Kumar: Conceptualization, methodology, formal analysis, investigation, writing - review and editing, visualization, and supervision.
Birla Roy Gnanamuthu: Conceptualization, methodology, formal analysis, investigation, writing - review and editing, and visualization.
Anuradha Chandramohan: Conceptualization, methodology, formal analysis, investigation, writing - review and editing, and visualization.
Arun Jacob Philip George: Conceptualization, methodology, formal analysis, investigation, writing - review and editing, and visualization
Nirmal Thampi John: Conceptualization, methodology, formal analysis, investigation, writing - review and editing, and visualization.
Bijesh Yadav: Formal analysis, data curation, and software.
Ajoy Oommen John: Conceptualization, methodology, formal analysis, writing - review and editing, and visualization.
Josh Thomas Georgy: Formal analysis, investigation, writing - original draft, and visualization.
Subhashini John: Formal analysis, investigation, writing - original draft, and visualization.
Raju Titus Chacko: Conceptualization, methodology, formal analysis, investigation, writing - review and editing, visualization, supervision, project administration, and funding acquisition.
Publication History
Article published online:
22 August 2022
© 2022. MedIntel Services Pvt Ltd. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)
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References
- 1 Powles TB, Bhardwa J, Shamash J, Mandalia S, Oliver T. The changing presentation of germ cell tumours of the testis between 1983 and 2002. BJU Int 2005; 95 (09) 1197-1200
- 2 Tandstad T, Smaaland R, Solberg A. et al. Management of seminomatous testicular cancer: a binational prospective population-based study from the Swedish Norwegian Testicular Cancer Study Group. J Clin Oncol 2011; 29 (06) 719-725
- 3 Flechon A, Bompas E, Biron P, Droz J-P. Management of post-chemotherapy residual masses in advanced seminoma. J Urol 2002; 168 (05) 1975-1979
- 4 Ravi R, Ong J, Oliver RT, Badenoch DF, Fowler CG, Hendry WF. The management of residual masses after chemotherapy in metastatic seminoma. BJU Int 1999; 83 (06) 649-653
- 5 Schultz SM, Einhorn LH, Conces Jr DJ, Williams SD, Loehrer PJ. Management of postchemotherapy residual mass in patients with advanced seminoma: Indiana University experience. J Clin Oncol 1989; 7 (10) 1497-1503
- 6 King J, Adra N, Einhorn LH. Management of residual disease after chemotherapy in germ cell tumors. Curr Opin Oncol 2020; 32 (03) 250-255
- 7 Puc HS, Heelan R, Mazumdar M. et al. Management of residual mass in advanced seminoma: results and recommendations from the Memorial Sloan-Kettering Cancer Center. J Clin Oncol 1996; 14 (02) 454-460
- 8 Herr HW, Sheinfeld J, Puc HS. et al. Surgery for a post-chemotherapy residual mass in seminoma. J Urol 1997; 157 (03) 860-862
- 9 Bilen MA, Hariri H, Leon C. et al. 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 (04) e147-e150
- 10 Mosharafa AA, Foster RS, Leibovich BC, Bihrle R, Johnson C, Donohue JP. Is post-chemotherapy resection of seminomatous elements associated with higher acute morbidity?. J Urol 2003; 169 (06) 2126-2128
- 11 De Santis M, Becherer A, Bokemeyer C. et al. 2-18fluoro-deoxy-D-glucose positron emission tomography is a reliable predictor for viable tumor in postchemotherapy seminoma: an update of the prospective multicentric SEMPET trial. J Clin Oncol 2004; 22 (06) 1034-1039
- 12 Saju SV, Radhakrishnan V, Ganesan TS. et al. Factors that impact the outcomes in testicular germ cell tumors in low-middle-income countries. Med Oncol 2019; 36 (03) 28
- 13 Joshi A, Zanwar S, Shetty N. et al. Epidemiology of male seminomatous and nonseminomatous germ cell tumors and response to first-line chemotherapy from a tertiary cancer center in India. Indian J Cancer 2016; 53 (02) 313-316
- 14 Sharma P, Jain TK, Parida GK. et al. Diagnostic accuracy of integrated (18)F-FDG PET/CT for restaging patients with malignant germ cell tumours. Br J Radiol 2014; 87 (1040): 20140263
- 15 Cathomas R, Klingbiel D, Bernard B. et al. Questioning the value of fluorodeoxyglucose positron emission tomography for residual lesions after chemotherapy for metastatic seminoma: results of an International Global Germ Cell Cancer Group Registry. J Clin Oncol 2018; 36: JCO1800210
- 16 Bachner M, Loriot Y, Gross-Goupil M. et al. 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 (01) 59-64
- 17 Treglia G, Sadeghi R, Annunziata S, Caldarella C, Bertagna F, Giovanella L. Diagnostic performance of fluorine-18-fluorodeoxyglucose positron emission tomography in the postchemotherapy management of patients with seminoma: systematic review and meta-analysis. BioMed Res Int 2014; 2014: 852681
- 18 Ganjoo KN, Chan RJ, Sharma M, Einhorn LH. Positron emission tomography scans in the evaluation of postchemotherapy residual masses in patients with seminoma. J Clin Oncol 1999; 17 (11) 3457-3460
- 19 Cheson BD, Fisher RI, Barrington SF. et al; Alliance, Australasian Leukaemia and Lymphoma Group, Eastern Cooperative Oncology Group, European Mantle Cell Lymphoma Consortium, Italian Lymphoma Foundation, European Organisation for Research, Treatment of Cancer/Dutch Hemato-Oncology Group, Grupo Español de Médula Ósea, German High-Grade Lymphoma Study Group, German Hodgkin's Study Group, Japanese Lymphorra Study Group, Lymphoma Study Association, NCIC Clinical Trials Group, Nordic Lymphoma Study Group, Southwest Oncology Group, United Kingdom National Cancer Research Institute. Recommendations for initial evaluation, staging, and response assessment of Hodgkin and non-Hodgkin lymphoma: the Lugano classification. J Clin Oncol 2014; 32 (27) 3059-3068
- 20 Dieckmann K-P, Radtke A, Geczi L. et al. Serum levels of microRNA-371a-3p (M371 test) as a new biomarker of testicular germ cell tumors: results of a prospective multicentric study. J Clin Oncol 2019; 37 (16) 1412-1423