Choriocarcinoma with pulmonary metastasis: report of a case of successful treatment with serial FDG-PET follow-up.

Abstract

BACKGROUND: This is the first report of successful treatment of a case of choriocarcinoma with pulmonary metastasis using serial 2-(18F)-fluoro-2-deoxy-D-glucose positron emission tomography (FDG-PET) before, during and after treatment. CASE: A 43-year-old woman, gravida 5, para 4, was admitted because of choriocarcinoma with pulmonary metastasis (International Federation of Gynecology and Obstetrics stage 3C). Her most recent pregnancy was a partial molar one 21 months earlier. She underwent laparoscopically assisted vaginal hysterectomy (LAVH) because of rising serum beta-human chorionic gonadotropin (beta-hCG) titers detected after the eighth multiagent chemotherapy (etoposide/methotrexate/actinomycin/cyclophosphamide/oncovin [EMA-CO]). Three additional courses of etoposide/methotrexate/actinomycin/ cisplatin/etoposide (EMA-CE) were given as consolidation therapy; the patient tolerated them well. FDG-PET examinations were given as follows: (1) before the first EMA-CO, January 13, 2004; (2) after the eighth EMA-CO, May 20, 2004; and (3) after LAVH and the third EMA-CE, October 4, 2004. CONCLUSION: Hysterectomy is effective if choriocarcinoma is resistant to multiagent chemotherapy, especially after FDG-PET has confirmed the uterine disease site. In comparison with serial serum beta-hCG, FDG-PET is a more accurate method of locating possible metastatic or persistent lesions, providing information on tumor activity and helping with therapeutic decision making.