18fluorodeoxyglucose positron emission tomography in the prediction of relapse in patients with high-risk, clinical stage I nonseminomatous germ cell tumors: preliminary report of MRC Trial TE22--the NCRI Testis Tumour Clinical Study Group
| Autor: | Paul Vasey, Gedske Daugaard, Anwar R. Padhani, Robert Huddart, Sally P. Stenning, Gordon J. S. Rustin, Jane E. Mackewn, Johnathan K Joffe, GM Mead, Michael O'Doherty, S. J. Harland, S F Hain, John P Logue, SJ Kirk |
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| Rok vydání: | 2007 |
| Předmět: |
Adult
Male Cancer Research Adolescent Lymphovascular invasion Risk Assessment Sensitivity and Specificity Disease-Free Survival Breast cancer Testicular Neoplasms Fluorodeoxyglucose F18 Predictive Value of Tests Medicine Humans Testicular cancer Cancer staging Neoplasm Staging Salvage Therapy medicine.diagnostic_test business.industry Melanoma Biopsy Needle Middle Aged medicine.disease Prognosis Combined Modality Therapy Survival Analysis Clinical trial Oncology Positron emission tomography Chemotherapy Adjuvant Positron-Emission Tomography Germ cell tumors Germinoma Neoplasm Recurrence Local business Nuclear medicine Orchiectomy |
| Zdroj: | Journal of clinical oncology : official journal of the American Society of Clinical Oncology. 25(21) |
| ISSN: | 1527-7755 |
| Popis: | Purpose There are several management options for patients with clinical stage I (CS1) nonseminomatous germ cell tumors (NSGCT); this study examined whether an 18fluorodeoxyglucose positron emission tomography (18FDG PET) scan could identify patients without occult metastatic disease for whom surveillance is an attractive option. Methods High-risk (lymphovascular invasion positive) patients with CS1 NSGCT underwent 18FDG PET scanning within 8 weeks of orchidectomy or marker normalization. PET-positive patients went off study; PET-negative patients were observed on a surveillance program. The primary outcome measure was the 2-year relapse-free rate (RFR) in patients with a negative PET scan (the negative predictive value). Assuming an RFR of 90% to exclude an RFR less than 80% with approximately 90% power, 100 PET-negative patients were required; 135 scanned patients were anticipated. Results Patients were registered between May 2002 and January 2005, when the trial was stopped by the independent data monitoring committee due to an unacceptably high relapse rate in the PET-negative patients. Of 116 registered patients, 111 underwent PET scans, and 88 (79%) were PET-negative (61% of preorchidectomy marker–negative patients v 88% of marker-positive patients; P = .002); 87 proceeded to surveillance, and one requested adjuvant chemotherapy. With a median follow-up of 12 months, 33 of 87 patients on surveillance relapsed (1-year RFR, 63%; 90% CI, 54% to 72%). Conclusion Though PET identified some patients with disease not detected by computed tomography scan, the relapse rate among PET negative patients remains high. The results show that 18FDG PET scanning is not sufficiently sensitive to identify patients at low risk of relapse in this setting. |
| Databáze: | OpenAIRE |
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