The role of positron emission tomography in germ cell cancer.
Positron emission tomography (PET) is a non-invasive tool for imaging regional metabolic processes, which adds another dimension to current anatomy-derived imaging techniques, i.e. metabolic imaging. To date, 2-(18)fluoro-2-deoxy-D-glucose (FDG) has been the only tracer used for imaging germ cell tumors (GCT), which can be distinguished from normal tissue by their different glucose utilization. However, FDG PET has several limitations: (1) inflammatory and granulomatous tissues also show extensive FDG uptake, (2) lesions <1 cm in size can often not be detected, and (3) mature teratoma is indistinguishable from normal and necrotic tissue. Studies assessing the clinical role of FDG PET in GCT suggest that the technique has a place as a standard tool in evaluating post chemotherapy seminoma residuals. Whether it also improves the assessment of the risks carried by clinical stage I non-seminoma patients and the early prediction of response to salvage chemotherapy is still under investigation, or at least needs to be confirmed by further trials. In relapsing patients with a mismatch between tumor markers and imaging data, FDG PET appears to be useful whenever salvage surgery is considered, although systematic trials are not yet available.
De Santis
Maria
M
Department of Medical Oncology, Kaiser Franz Josef Spital der Stadt Wien, Kundratstrasse 3, 1100 Wien, Austria.
Pont
Jörg
J
D000970:Antineoplastic Agents / Q000627:therapeutic use; D002945:Cisplatin / Q000627:therapeutic use; D019788:Fluorodeoxyglucose F18; D018237:Germinoma / Q000000981:diagnostic imaging* / Q000188:drug therapy / Q000601:surgery; D006801:Humans; D009364:Neoplasm Recurrence, Local; D009367:Neoplasm Staging / Q000379:methods; D018365:Neoplasm, Residual / Q000000981:diagnostic imaging / Q000601:surgery; D019275:Radiopharmaceuticals; D014055:Tomography, Emission-Computed
D000970:Antineoplastic Agents; D019275:Radiopharmaceuticals; D019788:Fluorodeoxyglucose F18; D002945:Cisplatin