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. 2023 Jul 17;15(14):3652.
doi: 10.3390/cancers15143652.

How [18F]-FDG-PET/CT Affects Clinical Management of Patients with Germ Cell Tumors in the Real World

Cecilia Liang  1 , Julia Sekler  1   2 , Brigitte Gückel  1   2 , Christina Pfannenberg  1 , Helmut Dittmann  2 , Ferdinand Seith  1 , Bastian Amend  3 , Konstantin Nikolaou  1   4   5 , Christian Philipp Reinert  1
Affiliations

How [18F]-FDG-PET/CT Affects Clinical Management of Patients with Germ Cell Tumors in the Real World

Cecilia Liang et al. Cancers (Basel). .

Abstract

Objective: The aim of this study was to evaluate the impact of PET/CT on clinical management of patients with germ cell tumors (GCTs) conducted in a real-world setting, including avoidance of invasive procedures, additional diagnostic imaging, and changes in treatment.

Methods: Patients with GCTs were prospectively enrolled into a PET/CT registry study between May 2013 and April 2021. Intended patient management prior and after PET/CT was documented using standardized questionnaires. Changes in oncologic staging and clinical management after PET/CT were recorded, including planned treatment and planned additional diagnostics.

Results: Forty-three male patients with GCTs were included consecutively in this study. After PET/CT, oncologic staging changed in 22/43 patients (51%), with upstaging in seven cases (16%), downstaging in ten cases (23%), and cancer relapse in five cases (11%). The number of patients with intended curative treatment remained stable, while a considerable change in intended therapeutic intervention was noted after PET/CT, with an increase in planned chemotherapy from three to eleven patients and a decrease in planned surgical resection from eleven to two patients. In addition, PET/CT contributed to preventing patients from intended invasive procedures including biopsy and surgery in 8/43 (19%) cases and from additional diagnostic procedures in 25 (58%) cases.

Conclusion: With the use of FDG-PET/CT as a tool to guide patient management in GCTs, we observed a notable impact on clinical staging and a consequent reduction in the need for additional invasive and diagnostic procedures. These findings are expected to be even more consequential in the future as treatment modalities improve and the life expectancy of GCT patients further increases.

Key points: PET/CT considerably influences the clinical stage of GCT patients. PET/CT has remarkable influence on the choice of therapeutic interventions and reduces additional diagnostic procedures.

Keywords: PET/CT; clinical management; germ cell tumors; seminoma.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
Inclusion criteria.
Figure 2
Figure 2
Alterations in the clinical stage of patients with GCTs following PET/CT examination.
Figure 3
Figure 3
[18F]FDG PET/CT and additional CT of patients with GCTs: (a,b) A patient with testicular seminoma and suspicious para-aortal lymph node on CT showing increased FDG uptake on PET/CT, leading to upstaging; (c,d) a patient with testicular seminoma and suspicious retroperitoneal lymph nodes on CT that appears without FDG uptake on PET/CT, resulting in downstaging; (e,f) a patient with mediastinal seminoma and residual mediastinal mass on CT that was found to be recurrent on PET/CT.
Figure 4
Figure 4
Sankey diagram depicting the alterations in the proposed treatment approach pre and post PET/CT scan, considering the input from referring physicians.
Figure 5
Figure 5
Sankey diagram depicting the alterations in intended additional imaging and invasive diagnostic procedures pre and post PET/CT scan, considering the input from referring physicians.
See this image and copyright information in PMC

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