Choriocarcinoma with pulmonary metastasis: report of a case of successful treatment with serial FDG-PET follow-up.
BACKGROUND
This is the first report of successful treatment of a case of choriocarcinoma with pulmonary metastasis using serial 2-(18F)-fluoro-2-deoxy-D-glucose positron emission tomography (FDG-PET) before, during and after treatment.


METHODS
A 43-year-old woman, gravida 5, para 4, was admitted because of choriocarcinoma with pulmonary metastasis (International Federation of Gynecology and Obstetrics stage 3C). Her most recent pregnancy was a partial molar one 21 months earlier. She underwent laparoscopically assisted vaginal hysterectomy (LAVH) because of rising serum beta-human chorionic gonadotropin (beta-hCG) titers detected after the eighth multiagent chemotherapy (etoposide/methotrexate/actinomycin/cyclophosphamide/oncovin [EMA-CO]). Three additional courses of etoposide/methotrexate/actinomycin/ cisplatin/etoposide (EMA-CE) were given as consolidation therapy; the patient tolerated them well. FDG-PET examinations were given as follows: (1) before the first EMA-CO, January 13, 2004; (2) after the eighth EMA-CO, May 20, 2004; and (3) after LAVH and the third EMA-CE, October 4, 2004.


CONCLUSIONS
Hysterectomy is effective if choriocarcinoma is resistant to multiagent chemotherapy, especially after FDG-PET has confirmed the uterine disease site. In comparison with serial serum beta-hCG, FDG-PET is a more accurate method of locating possible metastatic or persistent lesions, providing information on tumor activity and helping with therapeutic decision making.
Chang
Wei-Chun
WC
Department of Obstetrics and Gynecology, China Medical University Hospital, No. 2 Yuh-Der Road, Taichung 404, Taiwan, ROC. wei66@iris.seed.net.tw
Hung
Yao-Ching
YC
Shen
Huang-Ping
HP
Kao
Chia-Hung
CH
D000328:Adult; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D002822:Choriocarcinoma / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000556:secondary / Q000628:therapy; D003131:Combined Modality Therapy; D003937:Diagnosis, Differential; D005260:Female; D019788:Fluorodeoxyglucose F18; D006801:Humans; D007044:Hysterectomy; D008175:Lung Neoplasms / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000556:secondary / Q000628:therapy; D049268:Positron-Emission Tomography; D011247:Pregnancy; D019275:Radiopharmaceuticals; D014594:Uterine Neoplasms / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000473:pathology / Q000628:therapy
D019275:Radiopharmaceuticals; D019788:Fluorodeoxyglucose F18