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FDG-PET bei Keimzelltumoren

FDG-PET for germ cell tumors

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Zusammenfassung

Positronenemissionstomographie mit F-18-Fluordeoxyglukose (FDG-PET) ist eine Untersuchungsmethode, die eine funktionelle Darstellung der Tumoraktivität über den Glukosestoffwechsel ermöglicht und die morphologische Diagnostik der Computertomographie (CT) ergänzt. In der primären Stadieneinteilung von Keimzelltumoren (KZT) ist die Sensitivität der FDG-PET höher als die CT; insofern ist die routinemäßige Anwendung von FDG-PET statt einer CT möglich. Wegen fehlender klinischer Konsequenzen ist diese Verbesserung bei Seminomen nicht notwendig. Bei nichtseminomatösen KZT kann sie unter bestimmten Bedingungen hilfreich sein, z. B. wenn zwischen einem abwartenden Beobachten des Patienten oder der adjuvanten Gabe von Chemotherapien entschieden werden soll. Die Frage der Vitalität des Restbefunds wurde in mehreren Studien untersucht. Für bestimmte Situationen kann die FDG-PET bei nichtseminomatösen KZT relevante Zusatzinformationen erbringen, die jedoch kritisch im klinischen Kontext bewertet werden müssen, weil reifzellige Teratome keinen erhöhten Glukosestoffwechsel aufweisen und somit nicht darstellbar sind, sowie Entzündungen oder granulomatöse Erkrankungen falsch-positive Ergebnisse verursachen können. Bei Patienten mit Seminomen und Restbefunden nach Therapie hilft die FDG-PET zur Therapiesteuerung, da z. B. bei Restbefunden über 3 cm ohne FDG-Anreicherung durch PET die Resektion eines Resttumors vermieden werden kann, denn dieser entspricht einer Nekrose bzw. fibrotischem Narbengewebe. Es gibt nur wenige Daten zur Wertigkeit der FDG-PET bei einer unklaren Tumormarkererhöhung ohne morphologische Hinweise für ein Rezidiv oder zur frühen Kontrolle des Therapieansprechens unter Therapie. Hier kann sie möglicherweise hilfreiche Zusatzinformationen zur weiteren Therapieplanung liefern.

Abstract

Positron emission tomography employing 18-fluorodeoxyglucose (FDG-PET) adds a metabolic functional dimension to the morphologic diagnostics of computed tomography (CT), with elevated glucose metabolism as a parameter of tumor activity. Because the sensitivity of FDG-PET is higher than that of CT for primary staging of germ cell tumors, FDG-PET could be used instead of CT. No data exist for its use in seminomas, but additional FDG-PET may be useful under certain conditions in nonseminomatous germ cell tumors (NSGCT) when the physician must decide between different therapeutic strategies such as “watch-and-wait” or adjuvant chemotherapy. Several studies have investigated the viability of residual masses in NSGCT. For special clinical questions, FDG-PET is able to offer additional information, which should be interpreted carefully within the clinical context because mature teratomas do not show elevated glucose metabolism and cannot be distinguished from necrotic masses. Moreover, inflammation or granulomatous diseases may increase false-positive results. In patients with seminomas and residual tumours, FDG-PET allows for therapeutic decisions; for example, resection can be avoided in residual masses larger than 3 cm, without FDG accumulation. Only limited data are available concerning the use of FDG-PET in patients with tumor marker elevation without morphological evidence of relapse or early prediction of therapeutic outcome, but FDG-PET may be helpful for further therapeutic decision making.

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Authors and Affiliations

  1. Klinik für Innere Medizin – Hämatologie und Onkologie, Vivantes Klinikum Neukölln, Rudower Straße 48, 12351, Berlin, Deutschland

    M. de Wit

  2. Klinik und Poliklinik für Nuklearmedizin, Universitätsklinikum Carl-Gustav-Carus, Technische Universität Dresden, Dresden, Deutschland

    J. Kotzerke

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  1. M. de Wit
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Correspondence to M. de Wit.

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de Wit, M., Kotzerke, J. FDG-PET bei Keimzelltumoren. Onkologe 14, 581–586 (2008). https://doi.org/10.1007/s00761-008-1361-x

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  • DOI: https://doi.org/10.1007/s00761-008-1361-x

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