Positron emission tomography (PET) is not indicated in the postchemotherapy evaluation of advanced non-seminomatous testicular germ cell tumors

Excerpt

Testicular germ cell tumors (GCTs) represent the most common malignancy in young males and have become the paradigm of a curable neoplasm. Patients with advanced GCTs can achieve long-term disease-free survival when cisplatin-based chemotherapy is combined with expert and judicious resection of residual disease. Postchemotherapy radiologic imaging needs to be performed for all patients to determine whether further treatment is required (specifically, surgical resection of residual disease), provided there is the expected decline or normalization of tumor markers. This imaging should encompass all sites of previously known metastases and usually involves a computed tomography (CT) scan of the abdomen, chest and pelvis [1]. These oncologic principles have not been substantially changed in the last decades in spite of the availability of new imaging techniques such as magnetic resonance imaging or 18-fluorodeoxyglucose positron emission tomography (FDG-PET). In the setting of the Spanish Germ Cell Cancer Group consulting board, however, a recent concern has been risen about a growing (and unjustified) use of FDG-PET in non-seminomatous(NS) GCTs. By extrapolating results from other solid tumors and lymphoma studies, some oncologists erroneously believe that a negative PET scan precludes the need for resection of residual lesions. This attitude merits some comments. …