Skip to main content
SpringerLink
Log in

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

  • Original Article
  • Published:
European Journal of Nuclear Medicine and Molecular Imaging Aims and scope Submit manuscript

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.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

References

  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;15:2636–43

    PubMed  Google Scholar 

  2. Lehman E, Gershenson DM, Burke TW, Levenback C, Silva EG, Morris M. Salvage surgery for chemorefractory gestational trophoblastic disease. J Clin Oncol 1994;12:2737–42

    PubMed  Google Scholar 

  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;43:111–8

    PubMed  Google Scholar 

  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;82:415–9

    Article  PubMed  Google Scholar 

  5. Hricak H, Demas BE, Braga CA, Fisher MR, Winkler ML. Gestational trophoblastic neoplasm of the uterus: MR assessment. Radiology 1986;161:11–6

    PubMed  Google Scholar 

  6. Hillard AE, Allen RW, Beale G. Metastatic choriocarcinoma: correlation of MRI, CT, and angiography. South Med J 1993;86:1299–302

    PubMed  Google Scholar 

  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–93S

    PubMed  Google Scholar 

  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;21:3651–8

    Article  PubMed  Google Scholar 

  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;101:164–71

    Article  PubMed  Google Scholar 

  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;7:416–8

    PubMed  Google Scholar 

  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;70:843–5

    PubMed  Google Scholar 

  12. Zhuang H, Yamamoto AJ, Ghesani N, Alavi A. Detection of choriocarcinoma in the lung by FDG positron emission tomography. Clin Nucl Med 2001;26:723

    Article  PubMed  Google Scholar 

  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;3:37–40

    Article  PubMed  Google Scholar 

  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;91:226–30

    Article  PubMed  Google Scholar 

  15. Bagshawe KD. Choriocarcinoma. A model for tumour markers. Acta Oncol 1992;31:99–106

    PubMed  Google Scholar 

  16. World Health Organization. Gestational trophoblastic diseases. WHO Technical Report Series. Switzerland: WHO; 1983. p. 692

    Google Scholar 

  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;66:978–82

    PubMed  Google Scholar 

  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;30:1674–83

    Article  PubMed  Google Scholar 

  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;95:1051–4

    Article  PubMed  Google Scholar 

  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;56:231–4

    Article  PubMed  Google Scholar 

  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;75:874–85

    PubMed  Google Scholar 

  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;7:900–3

    PubMed  Google Scholar 

  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;68:183–92

    Article  PubMed  Google Scholar 

  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;70:192–4

    Article  PubMed  Google Scholar 

  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;82:1393–5

    Article  PubMed  Google Scholar 

Download references

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).

Author information

Authors and Affiliations

  1. Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Taoyuan, Taiwan

    Ting Chang Chang, Yen Ching Wu, Tzu I Wu & Chyong Huey Lai

  2. Department of Nuclear Medicine, Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Taoyuan, Taiwan

    Tzu Chen Yen & Yu Cheng Chang

  3. Department of Obstetrics and Gynecology, Kuo General Hospital, Tainan, Taiwan

    Yiu Tai Li

  4. Departments of Diagnostic Radiology, Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Taoyuan, Taiwan

    Koon Kwan Ng

  5. Anatomic Pathology, Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Taoyuan, Taiwan

    Shih Ming Jung

  6. Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital Linkou Medical Center, 5 Fu-Shin St., Kueishan, Taoyuan, 333, Taiwan

    Chyong Huey Lai

Authors
  1. Ting Chang Chang
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Tzu Chen Yen
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Yiu Tai Li
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Yen Ching Wu
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Yu Cheng Chang
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Koon Kwan Ng
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Shih Ming Jung
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Tzu I Wu
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Chyong Huey Lai
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Chyong Huey Lai.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Chang, T.C., Yen, T.C., Li, Y.T. et al. The role of 18F-fluorodeoxyglucose positron emission tomography in gestational trophoblastic tumours: a pilot study. Eur J Nucl Med Mol Imaging 33, 156–163 (2006). https://doi.org/10.1007/s00259-005-1873-1

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00259-005-1873-1

Keywords

Search

Navigation