Advertisement

The role of 18F-fluorodeoxyglucose positron emission tomography in gestational trophoblastic tumours: a pilot study

  • Ting Chang Chang
  • Tzu Chen Yen
  • Yiu Tai Li
  • Yen Ching Wu
  • Yu Cheng Chang
  • Koon Kwan Ng
  • Shih Ming Jung
  • Tzu I Wu
  • Chyong Huey LaiEmail author
Original Article

Abstract

Purpose

We conducted a pilot trial to evaluate the value of 18F-fluorodeoxyglucose (18F-FDG) positron emission tomography (PET) in gestational trophoblastic tumours (GTTs).

Methods

Patients with placental site trophoblastic tumour (PSTT), high-risk GTT (World Health Organisation score ≥8, disease onset at postpartum or greater than 6 months after antecedent pregnancy), metastatic GTT, recurrent/resistant GTT after chemotherapy, or post-molar GTT with unexplained abnormal β-hCG regression and patients undergoing re-evaluation after salvage treatment were enrolled. PET was undertaken within 1 week after computed tomography (CT). Clinical impacts of additional PET were determined on a scan basis.

Results

A total of 14 patients were recruited. Sixteen PET scans were performed, with one patient having three serial studies. Benefits of additional PET were seen in 7 of 16 (43.8%) scans; these benefits included disclosure of chemotherapy-resistant lesions (n=2), exclusion of false-positive CT lesions (n=1), detection of an additional lesion not found by conventional imaging (n=1) in high-risk GTT at the start of primary chemotherapy, and confirmation of complete response to treatment for PSTT or to salvage therapy for recurrent/resistant GTT (n=3). On the other hand, in two instances there were false-negative PET findings, six scans yielded no benefit, and one showed an indeterminate lesion.

Conclusion

Our preliminary results suggest that 18F-FDG PET is potentially useful in selected patients with GTT by providing precise mapping of metastases and tumour extent upfront, by monitoring treatment response and by localising viable tumours after chemotherapy. A larger study is necessary to further define the role of 18F-FDG PET in GTT.

Keywords

18F-FDG PET Gestational trophoblastic tumour β-hCG Chemoresistant 

Notes

Acknowledgements

This work was supported by grants from Chang Gung Memorial Hospital (CTRP 91-017) and the National Science Council of Taiwan (NSC 91-2314-B-182A-157 and NSC 92-2314-B-182A-184).

References

  1. 1.
    Bower M, Newlands ES, Holden L, Short D, Rustin GJ, Begent RH, et al. EMA/CO for high-risk gestational trophoblastic tumours: results from a cohort of 272 patients. J Clin Oncol 1997;15:2636–43PubMedGoogle Scholar
  2. 2.
    Lehman E, Gershenson DM, Burke TW, Levenback C, Silva EG, Morris M. Salvage surgery for chemorefractory gestational trophoblastic disease. J Clin Oncol 1994;12:2737–42PubMedGoogle Scholar
  3. 3.
    Newlands ES, Bower M, Holden L, Short D, Seckl MJ, Rustin GJ, et al. Management of resistant gestational trophoblastic tumours. J Reprod Med 1998;43:111–8PubMedGoogle Scholar
  4. 4.
    Feltmate CM, Genest DR, Wise L, Berstein MR, Goldstein DP, Berkowitz RS. Placental site trophoblastic tumour: a 17-year experience at the New England Trophoblastic Disease Center. Gynecol Oncol 2001;82:415–9CrossRefPubMedGoogle Scholar
  5. 5.
    Hricak H, Demas BE, Braga CA, Fisher MR, Winkler ML. Gestational trophoblastic neoplasm of the uterus: MR assessment. Radiology 1986;161:11–6PubMedGoogle Scholar
  6. 6.
    Hillard AE, Allen RW, Beale G. Metastatic choriocarcinoma: correlation of MRI, CT, and angiography. South Med J 1993;86:1299–302PubMedGoogle Scholar
  7. 7.
    Gambhir SS, Czenin J, Schwimmer J, Silverman DHS, Coleman RE, Phelps MW. A tabulated summary of the FDG PET literature. J Nucl Med 2001;42:1S–93SPubMedGoogle Scholar
  8. 8.
    Yen TC, Ng KK, Ma SY, Chou HH, Tsai CS, Hsueh S, et al. Value of dual-phase 2-fluoro-2-deoxy-d-glucose positron emission tomography in cervical cancer. J Clin Oncol 2003;21:3651–8CrossRefPubMedGoogle Scholar
  9. 9.
    Chang TC, Law KS, Hong JH, Lai CH, Yen TC, Ng KK, et al. Positron emission tomography for unexplained serum SCC-Ag elevation in cervical cancer patients—a phase II study. Cancer 2004;101:164–71CrossRefPubMedGoogle Scholar
  10. 10.
    Hebart H, Erley C, Kaskas B, Mayer R, Konig M, Einsele H, et al. Positron emission tomography helps to diagnose tumour emboli and residual disease in choriocarcinoma. Ann Oncol 1996;7:416–8PubMedGoogle Scholar
  11. 11.
    Truenbach J, Pereira PL, Huppert PE, Farnsworth C, Mayer R, Feline U, et al. Primary choriocarcinoma of the pulmonary artery mimicking pulmonary embolism. Br J Radiol 1997;70:843–5PubMedGoogle Scholar
  12. 12.
    Zhuang H, Yamamoto AJ, Ghesani N, Alavi A. Detection of choriocarcinoma in the lung by FDG positron emission tomography. Clin Nucl Med 2001;26:723CrossRefPubMedGoogle Scholar
  13. 13.
    Dose J, Bohuslavizki K, Huneke B, Lindner C, Janicke F. Detection of intramural choriocarcinoma of the uterus with 18F-FDG-PET. A case report. Clin Positron Imaging 2000;3:37–40CrossRefPubMedGoogle Scholar
  14. 14.
    Sironi S, Picchio M, Mangili G, Garavaglia E, Zangheri B, Messa C, et al. [18F]fluorodeoxyglucose positron emission tomography as a useful indicator of metastatic gestational trophoblastic tumour: preliminary results in three patients. Gynecol Oncol 2003;91:226–30CrossRefPubMedGoogle Scholar
  15. 15.
    Bagshawe KD. Choriocarcinoma. A model for tumour markers. Acta Oncol 1992;31:99–106PubMedGoogle Scholar
  16. 16.
    World Health Organization. Gestational trophoblastic diseases. WHO Technical Report Series. Switzerland: WHO; 1983. p. 692Google Scholar
  17. 17.
    Mutch DG, Soper JT, Babcock CJ, Clerke-Pearson DL, Hammond CB. Recurrent gestational trophoblastic disease. Experience of the Southern Regional Trophoblastic Disease Center. Cancer 1990;66:978–82PubMedGoogle Scholar
  18. 18.
    Tsai CC, Tsai CS, Ng KK, Ma SY, Chou HH, Tsai CS, et al. The impact of image fusion in resolving discrepant findings between FDG-PET and MRI/CT in patients with gynaecological cancers. Eur J Nucl Med Mol Imaging 2003;30:1674–83CrossRefPubMedGoogle Scholar
  19. 19.
    Matsui H, Suzuka K, Litsuka Y, Yamazawa K, Tanaka N, Mitsuhashi A, et al. Salvage combination chemotherapy with 5-fluorouracil and actinomycin D for patients with refractory, high-risk gestational trophoblastic tumours. Cancer 2002;95:1051–4CrossRefPubMedGoogle Scholar
  20. 20.
    Chen LP, Cai SM, Fan JX, Li ZT. PEBA regimen (cisplatin, etoposide, bleomycin, and adriamycin) in the treatment of drug-resistant choriocarcinoma. Gynecol Oncol 1995;56:231–4CrossRefPubMedGoogle Scholar
  21. 21.
    Lotz JP, Andre T, Donsimori R, Firmin C, Bouleuc C, Bonnak H, et al. High dose chemotherapy with ifosfamide, carboplatin, and etoposide combined with autologous bone marrow transplantation for the treatment of poor-prognosis germ cell tumours and metastatic trophoblastic disease in adults. Cancer 1995;75:874–85PubMedGoogle Scholar
  22. 22.
    Rustin GJS, Newlands ES, Begent RHJ, Dent J, Bagshawe KD. Weekly alternating etoposide, methotrexate, and actinomycin/vincristine and cyclophosphamide chemotherapy for the treatment of CNS metastases of choriocarcinoma. J Clin Oncol 1989;7:900–3PubMedGoogle Scholar
  23. 23.
    Schechter NR, Mychalczak B, Jones W, Spriggs D. Prognosis of patients treated with whole brain radiation therapy for metastatic gestational trophoblastic disease. Gynecol Oncol 1998;68:183–92CrossRefPubMedGoogle Scholar
  24. 24.
    Ngan HY, Chan FL, Au VWK, Cheng DKL, Ng TY, Wong LC. Clinical outcome of micrometastasis in the lung in stage IA persistent gestational trophoblastic disease. Gynecol Oncol 1998;70:192–4CrossRefPubMedGoogle Scholar
  25. 25.
    Gillespie AM, Kumar S, Hancock BW. Treatment of persistent trophoblastic diease later than 6 months after diagnosis of molar pregnancy. Br J Cancer 2000;82:1393–5CrossRefPubMedGoogle Scholar

Copyright information

© Springer-Verlag 2005

Authors and Affiliations

  • Ting Chang Chang
    • 1
  • Tzu Chen Yen
    • 2
  • Yiu Tai Li
    • 3
  • Yen Ching Wu
    • 1
  • Yu Cheng Chang
    • 2
  • Koon Kwan Ng
    • 4
  • Shih Ming Jung
    • 5
  • Tzu I Wu
    • 1
  • Chyong Huey Lai
    • 1
    • 6
    Email author
  1. 1.Division of Gynecologic Oncology, Department of Obstetrics and GynecologyChang Gung Memorial Hospital and Chang Gung University College of MedicineTaoyuanTaiwan
  2. 2.Department of Nuclear MedicineChang Gung Memorial Hospital and Chang Gung University College of MedicineTaoyuanTaiwan
  3. 3.Department of Obstetrics and GynecologyKuo General HospitalTainanTaiwan
  4. 4.Departments of Diagnostic RadiologyChang Gung Memorial Hospital and Chang Gung University College of MedicineTaoyuanTaiwan
  5. 5.Anatomic PathologyChang Gung Memorial Hospital and Chang Gung University College of MedicineTaoyuanTaiwan
  6. 6.Department of Obstetrics and GynecologyChang Gung Memorial Hospital Linkou Medical CenterTaoyuanTaiwan

Personalised recommendations