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Tomarchio V, Rigacci L. Fluorodeoxyglucose-Positron Emission Tomography in Relapsed/Refractory Hodgkin Lymphoma: A Practical Approach. Chemotherapy 2023; 69:1-10. [PMID: 37708879 PMCID: PMC10898808 DOI: 10.1159/000533766] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2023] [Accepted: 08/22/2023] [Indexed: 09/16/2023]
Abstract
BACKGROUND Positron emission tomography (PET) with the use of 18F-fluorodeoxyglucose (FDG), implemented with low-dosage computer tomography, is to be considered as the most important evolution of imaging in the management and assessment of classical Hodgkin lymphoma patients. SUMMARY According to Lugano response criteria, FDG-PET is mandatory to define metabolic response to frontline therapy and moreover it is important in the definition of nonresponders or refractory disease patients. Refractory disease is reported in about 15% of patients, with some variations based on the choice of first-line chemotherapy, and particularly in advanced stages, up to 40% eventually relapse within 3 years. KEY MESSAGES The aim of this review was to highlight a practical way to use FDG-PET in the subset of HL, with some notes of its use in first-line patients, and particularly centered on relapsed or refractory setting with a final focus of the evaluation of response by FDG-PET in the new treatment era of immunocheckpoint inhibitors.
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Affiliation(s)
| | - Luigi Rigacci
- Fondazione Policlinico Universitario Campus Bio-Medico, Rome, Italy
- Department of Medicine and Surgery, Research Unit of Hematology, Università Campus Bio-Medico, Rome, Italy
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2
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Al-Ibraheem A, Mottaghy FM, Juweid ME. PET/CT in Hodgkin Lymphoma: An Update. Semin Nucl Med 2023; 53:303-319. [PMID: 36369090 DOI: 10.1053/j.semnuclmed.2022.10.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2022] [Accepted: 10/25/2022] [Indexed: 11/11/2022]
Abstract
18F-FDG-PET/CT is now an integral part of the workup and management of patients with Hodgkin's lymphoma (HL). PET/CT is currently routinely performed for staging and for response assessment at the end of treatment. Interim PET/CT is typically performed after 1-4 of 6-8 chemo/chemoimmunotherapy cycles ± radiation for prognostication and potential treatment escalation or de-escalation early in the course of therapy, a concept known as response-or risk-adapted treatment. Quantitative PET is an area of growing interest. Metrics such as the standardized uptake value (SUV), metabolic tumor volume, total lesion glycolysis, and their changes with treatment are being investigated as more reproducible and, potentially, more accurate predictors of response and prognosis. Despite the progress made in standardizing the use of PET/CT in lymphoma, challenges remain, particularly with respect to its limited positive predictive value. This review highlights the most relevant applications of PET/CT in HL, its strengths and limitations, as well as recent efforts to implement PET/CT-based metrics as promising tools for precision medicine. Finally, the value of PET/CT for response assessment to immunotherapy is discussed.
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Affiliation(s)
- Akram Al-Ibraheem
- Department of Nuclear Medicine, King Hussein Cancer Center, Amman, Jordan; Division of Nuclear Medicine/Department of Radiology and Nuclear Medicine, University of Jordan, Amman, Jordan
| | - Felix M Mottaghy
- Department of Nuclear Medicine, University Hospital RWTH, Aachen University, Aachen, 52074, Germany, Center for Integrated Oncology Aachen Bonn Cologne Düsseldorf (CIO ABCD), Aachen, Germany and Department of Radiology and Nuclear Medicine, Maastricht University Medical Center, Maastricht, The Netherlands.
| | - Malik E Juweid
- Division of Nuclear Medicine/Department of Radiology and Nuclear Medicine, University of Jordan, Amman, Jordan
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3
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Guja KE, Nadel H, Iagaru A. Overview and Recent Advances in 18F-FDG PET/CT for Evaluation of Pediatric Lymphoma. Semin Nucl Med 2022. [DOI: 10.1053/j.semnuclmed.2022.10.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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4
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PET imaging of lymphomas. Nucl Med Mol Imaging 2022. [DOI: 10.1016/b978-0-12-822960-6.00047-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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5
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Hall MD, Terezakis SA, Lucas JT, Gallop-Evans E, Dieckmann K, Constine LS, Hodgson D, Flerlage JE, Metzger ML, Hoppe BS. Radiotherapy across pediatric Hodgkin lymphoma research group protocols: a report from the Staging, Evaluation, and Response Criteria Harmonization (SEARCH) for childhood, adolescent, and young adult Hodgkin lymphoma (CAYAHL) Group. Int J Radiat Oncol Biol Phys 2021; 112:317-334. [PMID: 34390770 PMCID: PMC8802654 DOI: 10.1016/j.ijrobp.2021.07.1716] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2021] [Revised: 07/23/2021] [Accepted: 07/31/2021] [Indexed: 01/17/2023]
Affiliation(s)
- Matthew D Hall
- Department of Radiation Oncology, Miami Cancer Institute, Baptist Health South Florida, Miami, FL, USA.
| | | | - John T Lucas
- Department of Radiation Oncology, St. Jude Children's Research Hospital, Memphis, TN, USA
| | - Eve Gallop-Evans
- Department of Clinical Oncology, Velindre Cancer Centre, Cardiff, Wales, United Kingdom
| | - Karin Dieckmann
- Department of Radiation Oncology, Medical University of Vienna, Vienna, Austria
| | - Louis S Constine
- Department of Radiation Oncology and Pediatrics, University of Rochester Medical Center, Rochester, NY, USA
| | - David Hodgson
- Department of Radiation Oncology, University of Toronto, Toronto, Alberta, Canada
| | - Jamie E Flerlage
- Department of Pediatric Oncology, St. Jude Children's Research Hospital, Memphis, TN, USA
| | - Monika L Metzger
- Department of Pediatric Oncology, St. Jude Children's Research Hospital, Memphis, TN, USA
| | - Bradford S Hoppe
- Department of Radiation Oncology, Mayo Clinic, Jacksonville, FL, USA
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Juweid ME, Mueller M, Alhouri A, A-Risheq MZ, Mottaghy FM. Positron emission tomography/computed tomography in the management of Hodgkin and B-cell non-Hodgkin lymphoma: An update. Cancer 2021; 127:3727-3741. [PMID: 34286864 DOI: 10.1002/cncr.33772] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2021] [Revised: 06/06/2021] [Accepted: 06/07/2021] [Indexed: 01/20/2023]
Abstract
18 F-fluorodeoxyglucose (FDG) positron emission tomography/computed tomography (PET/CT) is now an integral part of lymphoma staging and management. Because of its greater accuracy compared with CT alone, PET/CT is currently routinely performed for staging and for response assessment at the end of treatment in the vast majority of FDG-avid lymphomas and is the cornerstone of response classification for these lymphomas according to the Lugano classification. Interim PET/CT, typically performed after 2 to 4 of 6 to 8 chemotherapy/chemoimmunotherapy cycles with or without radiation, is commonly performed for prognostication and potential treatment escalation or de-escalation early in the course of therapy, a concept known as response-adapted or risk-adapted treatment. Quantitative PET is an area of growing interest. Metrics, such as the standardized uptake value, changes (Δ) in the standardized uptake value, metabolic tumor volume, and total lesion glycolysis, are being investigated as more reproducible and potentially more accurate predictors of response and prognosis. Despite the progress made in standardizing the use of PET/CT in lymphoma, challenges remain, particularly with respect to its limited positive predictive value, emphasizing the need for more specific molecular probes. This review highlights the most relevant applications of PET/CT in Hodgkin and B-cell non-Hodgkin lymphoma, its strengths and limitations, as well as recent efforts at implementing PET/CT-based metrics as promising tools for precision medicine.
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Affiliation(s)
- Malik E Juweid
- Division of Nuclear Medicine, Department of Radiology and Nuclear Medicine, University of Jordan, Amman, Jordan
| | - Marguerite Mueller
- Department of Nuclear Medicine, University Hospital Rheinish-Westphalian Technical University, Aachen University, Aachen, Germany
| | - Abdullah Alhouri
- Division of Nuclear Medicine, Department of Radiology and Nuclear Medicine, University of Jordan, Amman, Jordan
| | - M Ziad A-Risheq
- Division of Nuclear Medicine, Department of Radiology and Nuclear Medicine, University of Jordan, Amman, Jordan
| | - Felix M Mottaghy
- Department of Nuclear Medicine, University Hospital Rheinish-Westphalian Technical University, Aachen University, Aachen, Germany.,Department of Radiology and Nuclear Medicine, Maastricht University Medical Center, Maastricht, the Netherlands
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7
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Rodríguez Taroco MG, Cuña EG, Pages C, Schelotto M, González-Sprinberg GA, Castillo LA, Alonso O. Prognostic value of imaging markers from 18FDG-PET/CT in paediatric patients with Hodgkin lymphoma. Nucl Med Commun 2021; 42:306-314. [PMID: 33306628 DOI: 10.1097/mnm.0000000000001337] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
OBJECTIVE Identification of imaging prognostic parameters for early therapy personalisation to reduce treatment-related morbidity in paediatric Hodgkin lymphoma (HL). Our aim was to evaluate quantitative markers from baseline 2-[18F]fluoro-2-deoxy-d-glucose PET/CT as prognostic factors for treatment outcomes. Another goal was assessing the prognostic value of Deauville score at interim PET/CT. METHODS Twenty-one patients were prospectively enrolled. Median age was 12 years (range 6-17); 13 were female. Patients underwent PET/CT for disease staging (bPET), at the end of two cycles of chemotherapy (iPET) and after chemotherapy. A total of 173 lesions were segmented from bPET. We calculated 51 texture features for each lesion. Total metabolic tumour volume and total lesion glycolysis from bPET were calculated for response prediction at iPET. Univariate and multivariate analyses were used for optimal cut-off values to separate responders at iPET according to the Deauville score. RESULTS We identified four texture features as possible independent predictors of treatment outcomes at iPET. The areas under the ROC for univariate analysis were 0.89 (95% CI, 0.75-1), 0.82 (95% CI, 0.64-1), 0.79 (95% CI, 0.59-0.99) and 0.89 (95% CI, 0.75-1). The survival curves for patients assigned Deauville scores 1, 2, 3 and X were different from those assigned a score 4, with 4-year progression free-survival (PFS) rates of 85 versus 29%, respectively (P = 0.05). CONCLUSIONS We found four textural features as candidates for predicting early response to chemotherapy in paediatric patients with HL. The Deauville score at iPET was useful for differentiating PFS rates.
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Affiliation(s)
| | - Enrique G Cuña
- Uruguayan Centre of Molecular Imaging (CUDIM)
- Physics Institute, Sciences Faculty, University of the Republic
| | - Carolina Pages
- Paediatric Haemato Oncology Service, Pereira Rossell Hospital
| | | | | | - Luis A Castillo
- Paediatric Haemato Oncology Service, Pereira Rossell Hospital
| | - Omar Alonso
- Uruguayan Centre of Molecular Imaging (CUDIM)
- Nuclear Medicine and Molecular Imaging Centre, Clinical Hospital, Medicine Faculty, University of the Republic, Montevideo, Uruguay
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8
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Ragheb SR, Louka AL, Sharara SM. Lugano classification: response evaluation criteria for positron emission tomography/computed tomography in lymphoma follow-up. THE EGYPTIAN JOURNAL OF RADIOLOGY AND NUCLEAR MEDICINE 2020. [DOI: 10.1186/s43055-020-00303-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
The purpose of this study is to assess the role of 18 fluorodeoxyglucose positron emission tomography/computed tomography (18FDG PET-CT) in the follow-up of patients with lymphoma after finishing therapy.
Results
This study included 42 lymphomas (25 non-Hodgkin’s lymphoma and 17 Hodgkin’s lymphoma); patients ranging in age from 18 to 70 years were examined by 18FDG PET-CT after therapy and analyzed retrospectively. Confirmatory biopsy was mandatory in cases of suspected disease recurrence and follow-up in cases of complete metabolic response. Positron emission tomography/computed tomography in assessment of lymphoma treatment response reveals significant statistical significance (P < 0.05). It shows 100% sensitivity, 92.8% specificity, and 95.2% accuracy in the prediction of response.
Conclusion
Positron emission tomography/computed tomography plays an important role in detection of response to treatment of lymphoma after finishing therapy.
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Ghesani N, Gavane S, Hafez A, Kostakoglu L. PET in Lymphoma. Clin Nucl Med 2020. [DOI: 10.1007/978-3-030-39457-8_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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10
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Voltin CA, Goergen H, Baues C, Fuchs M, Mettler J, Kreissl S, Oertl J, Klaeser B, Moccia A, Drzezga A, Engert A, Borchmann P, Dietlein M, Kobe C. Value of bone marrow biopsy in Hodgkin lymphoma patients staged by FDG PET: results from the German Hodgkin Study Group trials HD16, HD17, and HD18. Ann Oncol 2019; 29:1926-1931. [PMID: 30010775 DOI: 10.1093/annonc/mdy250] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Background Bone marrow (BM) involvement defines advanced-stage Hodgkin lymphoma and thus has impact on the assignment to treatment. Our aim was to evaluate whether the established BM biopsy may be omitted in patients if 18F-fluorodeoxyglucose positron emission tomography (PET) scanning is carried out during staging. Patients and methods Our analysis set consisted of 832 Hodgkin lymphoma patients from the German Hodgkin Study Group trials HD16, HD17, and HD18 who underwent both PET scanning and BM biopsy before treatment. All PET studies were centrally reviewed and BM was categorized as showing focal involvement or not. Results Taking BM biopsy as reference standard, baseline PET showed a negative predictive value of 99.9% [95% confidence interval (CI) 99.2% to 100%] with true-negative results in 702 of 703 cases. The sensitivity of PET for detecting BM involvement was 95.0% (95% CI 75.1% to 99.9%) as it could identify 19 out of 20 patients with positive BM biopsy. Moreover, PET found 110 additional subjects with focal BM lesions who would have been considered negative by biopsy. Conclusions When compared with BM biopsy, PET was able to detect focal BM lesions in a large number of additional patients. This indicates that conventional BM biopsy may substantially underestimate the actual incidence of BM involvement. Given the high negative predictive value, baseline PET scanning can safely be used to exclude BM involvement in Hodgkin lymphoma. BM biopsy should be considered only in such patients in whom PET-detected lesions lead to a change of treatment protocol. Registered trials The trials included in this analysis were registered at ClinicalTrials.gov: HD16-NCT00736320, HD17-NCT01356680, and HD18-NCT00515554.
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Affiliation(s)
- C-A Voltin
- Department of Nuclear Medicine, University Hospital of Cologne, Cologne, Germany
| | - H Goergen
- German Hodgkin Study Group (GHSG), Department of Internal Medicine I, University Hospital of Cologne, Cologne, Germany
| | - C Baues
- Departments of Radiation Oncology, University Hospital of Cologne, Cologne, Germany
| | - M Fuchs
- German Hodgkin Study Group (GHSG), Department of Internal Medicine I, University Hospital of Cologne, Cologne, Germany
| | - J Mettler
- Department of Nuclear Medicine, University Hospital of Cologne, Cologne, Germany
| | - S Kreissl
- Departments of Internal Medicine I, University Hospital of Cologne, Cologne, Germany
| | - J Oertl
- Department of Nuclear Medicine, University Hospital of Cologne, Cologne, Germany
| | - B Klaeser
- Department of Nuclear Medicine, Inselspital, Bern University Hospital and University of Bern, Bern; Swiss Group for Clinical Cancer Research (SAKK), Bern
| | - A Moccia
- Swiss Group for Clinical Cancer Research (SAKK), Bern; Department of Medical Oncology, Oncology Institute of Southern Switzerland (IOSI), Bellinzona, Switzerland
| | - A Drzezga
- Department of Nuclear Medicine, University Hospital of Cologne, Cologne, Germany
| | - A Engert
- Departments of Internal Medicine I, University Hospital of Cologne, Cologne, Germany
| | - P Borchmann
- Departments of Internal Medicine I, University Hospital of Cologne, Cologne, Germany
| | - M Dietlein
- Department of Nuclear Medicine, University Hospital of Cologne, Cologne, Germany
| | - C Kobe
- Department of Nuclear Medicine, University Hospital of Cologne, Cologne, Germany.
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Makita S, Maruyama D, Maeshima AM, Taniguchi H, Yuda S, Toyoda K, Yamauchi N, Fukuhara S, Munakata W, Kobayashi Y, Kurihara H, Izutsu K, Tobinai K. A comparison of clinical staging using the Lugano versus Ann Arbor classifications in Japanese patients with Hodgkin lymphoma. Asia Pac J Clin Oncol 2019; 16:108-114. [PMID: 31802636 DOI: 10.1111/ajco.13248] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2018] [Accepted: 09/01/2019] [Indexed: 12/01/2022]
Abstract
AIMS The Lugano classification is a novel staging system for lymphomas established in 2014. In this staging system, 18 F-fluorodeoxyglucose-positron emission tomography/computed tomography (FDG-PET/CT) was formally incorporated into standard staging for FDG-avid lymphomas, including Hodgkin lymphoma (HL). We retrospectively analyzed patients with HL who were newly diagnosed and treated at our institution to evaluate the utility of the Lugano classification compared to the Ann Arbor classification in Japanese patients with this type of lymphoma. METHODS Patients newly diagnosed with HL between 2005 and 2011 were identified through our departmental database. Data from neck-chest-abdomen-pelvis CT scans, BM examinations, and FDG-PET/CT that were routinely performed for staging at our clinical practice were retrieved and analyzed. RESULTS Fifty-four patients with a median age of 35.5 years (range: 15-78 years) were investigated in this retrospective study. The Lugano stage matched the Ann Arbor stage in 46 patients (85%). Six patients (11%) were upstaged while two (4%) were downstaged per the Lugano classification. Four patients (7%) were converted from early stage to advanced stage, but none was converted in the reverse. Among 11 patients (20%) with PET-positive bone/bone marrow lesions, only one (2%) exhibited biopsy-proven bone marrow involvement of HL cells. CONCLUSION Our data revealed a high concordance rate between the Lugano and Ann Arbor staging system in Japanese patients with HL. Because of its low diagnostic value, routine bone marrow examination might be unnecessary for staging when FDG-PET/CT is used as a substitute.
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Affiliation(s)
- Shinichi Makita
- Department of Hematology, National Cancer Center Hospital, Tokyo, Japan
| | - Dai Maruyama
- Department of Hematology, National Cancer Center Hospital, Tokyo, Japan
| | | | | | - Sayako Yuda
- Department of Hematology, National Cancer Center Hospital, Tokyo, Japan
| | - Kosuke Toyoda
- Department of Hematology, National Cancer Center Hospital, Tokyo, Japan
| | - Nobuhiko Yamauchi
- Department of Hematology, National Cancer Center Hospital, Tokyo, Japan
| | - Suguru Fukuhara
- Department of Hematology, National Cancer Center Hospital, Tokyo, Japan
| | - Wataru Munakata
- Department of Hematology, National Cancer Center Hospital, Tokyo, Japan
| | - Yukio Kobayashi
- Department of Hematology, National Cancer Center Hospital, Tokyo, Japan
| | - Hiroaki Kurihara
- Department of Diagnostic Radiology, National Cancer Center Hospital, Tokyo, Japan
| | - Koji Izutsu
- Department of Hematology, National Cancer Center Hospital, Tokyo, Japan
| | - Kensei Tobinai
- Department of Hematology, National Cancer Center Hospital, Tokyo, Japan
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Daza JF, Solis NM, Parpia S, Gallinger S, Moulton CA, Belley-Cote EP, Levine MN, Serrano PE. A meta-analysis exploring the role of PET and PET-CT in the management of potentially resectable colorectal cancer liver metastases. Eur J Surg Oncol 2019; 45:1341-1348. [DOI: 10.1016/j.ejso.2019.03.025] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2019] [Revised: 03/01/2019] [Accepted: 03/18/2019] [Indexed: 02/03/2023] Open
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Zaucha JM, Chauvie S, Zaucha R, Biggii A, Gallamini A. The role of PET/CT in the modern treatment of Hodgkin lymphoma. Cancer Treat Rev 2019; 77:44-56. [PMID: 31260900 DOI: 10.1016/j.ctrv.2019.06.002] [Citation(s) in RCA: 41] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2018] [Revised: 05/06/2019] [Accepted: 06/09/2019] [Indexed: 12/12/2022]
Abstract
Classical Hodgkin Lymphoma is distinguished from other lymphomas by its peculiar biology and heterogeneous chemosensitivity. Most of the patients respond to the standard first-line treatment and are cured, however, in selected cases, the disease relapses or remains primarily refractory. Among predictive/prognostic factors 18FDG positron emission tomography (PET), fully integrated with computed tomography (PET/CT) proved to be extremely useful in identifying patients with poor prognosis at the time of diagnosis, during and at the end of treatment. The aim of this review is to present the current role of PET/CT in cHL at staging, interim and end of therapy assessment and its ability to guide treatment with a response- and risk-adapted strategy in clinical practice. Finally, quantitative PET measurement and the concurrent use of PET with selected biomarkers are discussed.
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Affiliation(s)
- Jan Maciej Zaucha
- Department of Hematology and Transplantology, Medical University of Gdańsk, Poland.
| | - Stephane Chauvie
- Department of Medical Physics, Santa Croce e Carle Hospital, Cuneo, Italy
| | - Renata Zaucha
- Department of Oncology and Radiotherapy, Medical University of Gdańsk, Poland
| | - Alberto Biggii
- Department of Nuclear Medicine, Santa Croce e Carle Hospital, Cuneo, Italy
| | - Andrea Gallamini
- Department of Research and Clinical Innovation, A. Lacassagne Cancer Center, Nice, France
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14
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Comparison of 18F FDG PET-CT AND CECT in pretreatment staging of adults with Hodgkin’s lymphoma. Leuk Res 2019; 76:48-52. [DOI: 10.1016/j.leukres.2018.11.018] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2018] [Revised: 11/29/2018] [Accepted: 11/30/2018] [Indexed: 11/23/2022]
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15
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Metser U, Prica A, Hodgson DC, Mozuraitis M, Eberg M, Mak V, Green B, Singnurkar A, Dudebout J, MacCrostie P, Tau N, Mittmann N, Langer DL. Effect of PET/CT on the Management and Outcomes of Participants with Hodgkin and Aggressive Non-Hodgkin Lymphoma: A Multicenter Registry. Radiology 2018; 290:488-495. [PMID: 30511907 DOI: 10.1148/radiol.2018181519] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Purpose To determine the relationship of PET/CT staging to the management and outcomes of participants with apparent limited-stage (LS) Hodgkin lymphoma (HL) or aggressive non-HL (ANHL) treated with curative intent. Materials and Methods This prospective multicenter registry included 850 participants (467 men and 383 women; median age, 54.1 years) from nine centers who had LS HL or ANHL on the basis of clinical data and CT, or with equivocal CT for advanced stage, who were considered for curative-intent first-line therapy. Participants were recruited between May 1, 2013, and December 31, 2015. Pre-PET/CT treatment plan was compared with treatment provided. Survival and second-line therapy initiation were compared with an historical control pool staged by using CT alone. Administrative data sources were used to control for baseline characteristics. Outcomes were assessed by using adjusted Cox proportional hazards regression and propensity score matching. Results PET/CT helped to upstage 150 of 850 participants (17.6%). There was a change in planned therapy in 224 of 580 (38.6%) of participants after PET/CT. There was a lower 1-year mortality for participants with ANHL in the PET/CT versus CT cohort (hazard ratio, 0.63; 95% confidence interval: 0.40, 1.0; P < .05) and for those with LS at PET/CT compared with those with LS at CT (hazard ratio, 0.40; 95% confidence interval: 0.21, 0.74; P = .004). For participants with HL, no 1-year outcome difference was found (P = .16). Conclusion PET/CT helped to upstage approximately 18% of participants and planned management was frequently altered. Participants with aggressive non-Hodgkin lymphoma whose first-line therapy was guided by PET/CT had significantly better survival compared with participants whose treatment was guided by CT. © RSNA, 2018 Online supplemental material is available for this article. See also the editorial by Scott in this issue.
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Affiliation(s)
- Ur Metser
- From the Joint Department of Medical Imaging, University Health Network, Mount Sinai Hospital & Women's College Hospital, University of Toronto, 610 University Ave, Suite 3-960, Toronto, ON M5G 2M9, Canada (U.M., N.T.); Department of Medical Oncology and Hematology, Princess Margaret Cancer Centre, Toronto, ON, Canada (A.P.); Department of Radiation Oncology, University of Toronto, and Radiation Medicine Program, Princess Margaret Cancer Centre, Toronto, ON, Canada (D.C.H.); Cancer Analytics, Analytics & Informatics (M.M., M.E., V.M.), Quality Measurement and Evaluation, Clinical Programs and Quality Initiatives (B.G.), Cancer Imaging, Clinical Programs and Quality Initiatives (P.M.), and Research Office, Analytics & Informatics (N.M., D.L.L.), Cancer Care Ontario, Toronto, ON, Canada; Department of Nuclear Medicine and Molecular Imaging, Hamilton Health Sciences, McMaster University, Hamilton, ON, Canada (A.S.); and Department of Oncology, Cancer Centre of Southeastern Ontario, Queen's University, Kingston, ON, Canada (J.D.)
| | - Anca Prica
- From the Joint Department of Medical Imaging, University Health Network, Mount Sinai Hospital & Women's College Hospital, University of Toronto, 610 University Ave, Suite 3-960, Toronto, ON M5G 2M9, Canada (U.M., N.T.); Department of Medical Oncology and Hematology, Princess Margaret Cancer Centre, Toronto, ON, Canada (A.P.); Department of Radiation Oncology, University of Toronto, and Radiation Medicine Program, Princess Margaret Cancer Centre, Toronto, ON, Canada (D.C.H.); Cancer Analytics, Analytics & Informatics (M.M., M.E., V.M.), Quality Measurement and Evaluation, Clinical Programs and Quality Initiatives (B.G.), Cancer Imaging, Clinical Programs and Quality Initiatives (P.M.), and Research Office, Analytics & Informatics (N.M., D.L.L.), Cancer Care Ontario, Toronto, ON, Canada; Department of Nuclear Medicine and Molecular Imaging, Hamilton Health Sciences, McMaster University, Hamilton, ON, Canada (A.S.); and Department of Oncology, Cancer Centre of Southeastern Ontario, Queen's University, Kingston, ON, Canada (J.D.)
| | - David C Hodgson
- From the Joint Department of Medical Imaging, University Health Network, Mount Sinai Hospital & Women's College Hospital, University of Toronto, 610 University Ave, Suite 3-960, Toronto, ON M5G 2M9, Canada (U.M., N.T.); Department of Medical Oncology and Hematology, Princess Margaret Cancer Centre, Toronto, ON, Canada (A.P.); Department of Radiation Oncology, University of Toronto, and Radiation Medicine Program, Princess Margaret Cancer Centre, Toronto, ON, Canada (D.C.H.); Cancer Analytics, Analytics & Informatics (M.M., M.E., V.M.), Quality Measurement and Evaluation, Clinical Programs and Quality Initiatives (B.G.), Cancer Imaging, Clinical Programs and Quality Initiatives (P.M.), and Research Office, Analytics & Informatics (N.M., D.L.L.), Cancer Care Ontario, Toronto, ON, Canada; Department of Nuclear Medicine and Molecular Imaging, Hamilton Health Sciences, McMaster University, Hamilton, ON, Canada (A.S.); and Department of Oncology, Cancer Centre of Southeastern Ontario, Queen's University, Kingston, ON, Canada (J.D.)
| | - Mindaugas Mozuraitis
- From the Joint Department of Medical Imaging, University Health Network, Mount Sinai Hospital & Women's College Hospital, University of Toronto, 610 University Ave, Suite 3-960, Toronto, ON M5G 2M9, Canada (U.M., N.T.); Department of Medical Oncology and Hematology, Princess Margaret Cancer Centre, Toronto, ON, Canada (A.P.); Department of Radiation Oncology, University of Toronto, and Radiation Medicine Program, Princess Margaret Cancer Centre, Toronto, ON, Canada (D.C.H.); Cancer Analytics, Analytics & Informatics (M.M., M.E., V.M.), Quality Measurement and Evaluation, Clinical Programs and Quality Initiatives (B.G.), Cancer Imaging, Clinical Programs and Quality Initiatives (P.M.), and Research Office, Analytics & Informatics (N.M., D.L.L.), Cancer Care Ontario, Toronto, ON, Canada; Department of Nuclear Medicine and Molecular Imaging, Hamilton Health Sciences, McMaster University, Hamilton, ON, Canada (A.S.); and Department of Oncology, Cancer Centre of Southeastern Ontario, Queen's University, Kingston, ON, Canada (J.D.)
| | - Maria Eberg
- From the Joint Department of Medical Imaging, University Health Network, Mount Sinai Hospital & Women's College Hospital, University of Toronto, 610 University Ave, Suite 3-960, Toronto, ON M5G 2M9, Canada (U.M., N.T.); Department of Medical Oncology and Hematology, Princess Margaret Cancer Centre, Toronto, ON, Canada (A.P.); Department of Radiation Oncology, University of Toronto, and Radiation Medicine Program, Princess Margaret Cancer Centre, Toronto, ON, Canada (D.C.H.); Cancer Analytics, Analytics & Informatics (M.M., M.E., V.M.), Quality Measurement and Evaluation, Clinical Programs and Quality Initiatives (B.G.), Cancer Imaging, Clinical Programs and Quality Initiatives (P.M.), and Research Office, Analytics & Informatics (N.M., D.L.L.), Cancer Care Ontario, Toronto, ON, Canada; Department of Nuclear Medicine and Molecular Imaging, Hamilton Health Sciences, McMaster University, Hamilton, ON, Canada (A.S.); and Department of Oncology, Cancer Centre of Southeastern Ontario, Queen's University, Kingston, ON, Canada (J.D.)
| | - Victor Mak
- From the Joint Department of Medical Imaging, University Health Network, Mount Sinai Hospital & Women's College Hospital, University of Toronto, 610 University Ave, Suite 3-960, Toronto, ON M5G 2M9, Canada (U.M., N.T.); Department of Medical Oncology and Hematology, Princess Margaret Cancer Centre, Toronto, ON, Canada (A.P.); Department of Radiation Oncology, University of Toronto, and Radiation Medicine Program, Princess Margaret Cancer Centre, Toronto, ON, Canada (D.C.H.); Cancer Analytics, Analytics & Informatics (M.M., M.E., V.M.), Quality Measurement and Evaluation, Clinical Programs and Quality Initiatives (B.G.), Cancer Imaging, Clinical Programs and Quality Initiatives (P.M.), and Research Office, Analytics & Informatics (N.M., D.L.L.), Cancer Care Ontario, Toronto, ON, Canada; Department of Nuclear Medicine and Molecular Imaging, Hamilton Health Sciences, McMaster University, Hamilton, ON, Canada (A.S.); and Department of Oncology, Cancer Centre of Southeastern Ontario, Queen's University, Kingston, ON, Canada (J.D.)
| | - Bo Green
- From the Joint Department of Medical Imaging, University Health Network, Mount Sinai Hospital & Women's College Hospital, University of Toronto, 610 University Ave, Suite 3-960, Toronto, ON M5G 2M9, Canada (U.M., N.T.); Department of Medical Oncology and Hematology, Princess Margaret Cancer Centre, Toronto, ON, Canada (A.P.); Department of Radiation Oncology, University of Toronto, and Radiation Medicine Program, Princess Margaret Cancer Centre, Toronto, ON, Canada (D.C.H.); Cancer Analytics, Analytics & Informatics (M.M., M.E., V.M.), Quality Measurement and Evaluation, Clinical Programs and Quality Initiatives (B.G.), Cancer Imaging, Clinical Programs and Quality Initiatives (P.M.), and Research Office, Analytics & Informatics (N.M., D.L.L.), Cancer Care Ontario, Toronto, ON, Canada; Department of Nuclear Medicine and Molecular Imaging, Hamilton Health Sciences, McMaster University, Hamilton, ON, Canada (A.S.); and Department of Oncology, Cancer Centre of Southeastern Ontario, Queen's University, Kingston, ON, Canada (J.D.)
| | - Amit Singnurkar
- From the Joint Department of Medical Imaging, University Health Network, Mount Sinai Hospital & Women's College Hospital, University of Toronto, 610 University Ave, Suite 3-960, Toronto, ON M5G 2M9, Canada (U.M., N.T.); Department of Medical Oncology and Hematology, Princess Margaret Cancer Centre, Toronto, ON, Canada (A.P.); Department of Radiation Oncology, University of Toronto, and Radiation Medicine Program, Princess Margaret Cancer Centre, Toronto, ON, Canada (D.C.H.); Cancer Analytics, Analytics & Informatics (M.M., M.E., V.M.), Quality Measurement and Evaluation, Clinical Programs and Quality Initiatives (B.G.), Cancer Imaging, Clinical Programs and Quality Initiatives (P.M.), and Research Office, Analytics & Informatics (N.M., D.L.L.), Cancer Care Ontario, Toronto, ON, Canada; Department of Nuclear Medicine and Molecular Imaging, Hamilton Health Sciences, McMaster University, Hamilton, ON, Canada (A.S.); and Department of Oncology, Cancer Centre of Southeastern Ontario, Queen's University, Kingston, ON, Canada (J.D.)
| | - Jill Dudebout
- From the Joint Department of Medical Imaging, University Health Network, Mount Sinai Hospital & Women's College Hospital, University of Toronto, 610 University Ave, Suite 3-960, Toronto, ON M5G 2M9, Canada (U.M., N.T.); Department of Medical Oncology and Hematology, Princess Margaret Cancer Centre, Toronto, ON, Canada (A.P.); Department of Radiation Oncology, University of Toronto, and Radiation Medicine Program, Princess Margaret Cancer Centre, Toronto, ON, Canada (D.C.H.); Cancer Analytics, Analytics & Informatics (M.M., M.E., V.M.), Quality Measurement and Evaluation, Clinical Programs and Quality Initiatives (B.G.), Cancer Imaging, Clinical Programs and Quality Initiatives (P.M.), and Research Office, Analytics & Informatics (N.M., D.L.L.), Cancer Care Ontario, Toronto, ON, Canada; Department of Nuclear Medicine and Molecular Imaging, Hamilton Health Sciences, McMaster University, Hamilton, ON, Canada (A.S.); and Department of Oncology, Cancer Centre of Southeastern Ontario, Queen's University, Kingston, ON, Canada (J.D.)
| | - Pamela MacCrostie
- From the Joint Department of Medical Imaging, University Health Network, Mount Sinai Hospital & Women's College Hospital, University of Toronto, 610 University Ave, Suite 3-960, Toronto, ON M5G 2M9, Canada (U.M., N.T.); Department of Medical Oncology and Hematology, Princess Margaret Cancer Centre, Toronto, ON, Canada (A.P.); Department of Radiation Oncology, University of Toronto, and Radiation Medicine Program, Princess Margaret Cancer Centre, Toronto, ON, Canada (D.C.H.); Cancer Analytics, Analytics & Informatics (M.M., M.E., V.M.), Quality Measurement and Evaluation, Clinical Programs and Quality Initiatives (B.G.), Cancer Imaging, Clinical Programs and Quality Initiatives (P.M.), and Research Office, Analytics & Informatics (N.M., D.L.L.), Cancer Care Ontario, Toronto, ON, Canada; Department of Nuclear Medicine and Molecular Imaging, Hamilton Health Sciences, McMaster University, Hamilton, ON, Canada (A.S.); and Department of Oncology, Cancer Centre of Southeastern Ontario, Queen's University, Kingston, ON, Canada (J.D.)
| | - Noam Tau
- From the Joint Department of Medical Imaging, University Health Network, Mount Sinai Hospital & Women's College Hospital, University of Toronto, 610 University Ave, Suite 3-960, Toronto, ON M5G 2M9, Canada (U.M., N.T.); Department of Medical Oncology and Hematology, Princess Margaret Cancer Centre, Toronto, ON, Canada (A.P.); Department of Radiation Oncology, University of Toronto, and Radiation Medicine Program, Princess Margaret Cancer Centre, Toronto, ON, Canada (D.C.H.); Cancer Analytics, Analytics & Informatics (M.M., M.E., V.M.), Quality Measurement and Evaluation, Clinical Programs and Quality Initiatives (B.G.), Cancer Imaging, Clinical Programs and Quality Initiatives (P.M.), and Research Office, Analytics & Informatics (N.M., D.L.L.), Cancer Care Ontario, Toronto, ON, Canada; Department of Nuclear Medicine and Molecular Imaging, Hamilton Health Sciences, McMaster University, Hamilton, ON, Canada (A.S.); and Department of Oncology, Cancer Centre of Southeastern Ontario, Queen's University, Kingston, ON, Canada (J.D.)
| | - Nicole Mittmann
- From the Joint Department of Medical Imaging, University Health Network, Mount Sinai Hospital & Women's College Hospital, University of Toronto, 610 University Ave, Suite 3-960, Toronto, ON M5G 2M9, Canada (U.M., N.T.); Department of Medical Oncology and Hematology, Princess Margaret Cancer Centre, Toronto, ON, Canada (A.P.); Department of Radiation Oncology, University of Toronto, and Radiation Medicine Program, Princess Margaret Cancer Centre, Toronto, ON, Canada (D.C.H.); Cancer Analytics, Analytics & Informatics (M.M., M.E., V.M.), Quality Measurement and Evaluation, Clinical Programs and Quality Initiatives (B.G.), Cancer Imaging, Clinical Programs and Quality Initiatives (P.M.), and Research Office, Analytics & Informatics (N.M., D.L.L.), Cancer Care Ontario, Toronto, ON, Canada; Department of Nuclear Medicine and Molecular Imaging, Hamilton Health Sciences, McMaster University, Hamilton, ON, Canada (A.S.); and Department of Oncology, Cancer Centre of Southeastern Ontario, Queen's University, Kingston, ON, Canada (J.D.)
| | - Deanna L Langer
- From the Joint Department of Medical Imaging, University Health Network, Mount Sinai Hospital & Women's College Hospital, University of Toronto, 610 University Ave, Suite 3-960, Toronto, ON M5G 2M9, Canada (U.M., N.T.); Department of Medical Oncology and Hematology, Princess Margaret Cancer Centre, Toronto, ON, Canada (A.P.); Department of Radiation Oncology, University of Toronto, and Radiation Medicine Program, Princess Margaret Cancer Centre, Toronto, ON, Canada (D.C.H.); Cancer Analytics, Analytics & Informatics (M.M., M.E., V.M.), Quality Measurement and Evaluation, Clinical Programs and Quality Initiatives (B.G.), Cancer Imaging, Clinical Programs and Quality Initiatives (P.M.), and Research Office, Analytics & Informatics (N.M., D.L.L.), Cancer Care Ontario, Toronto, ON, Canada; Department of Nuclear Medicine and Molecular Imaging, Hamilton Health Sciences, McMaster University, Hamilton, ON, Canada (A.S.); and Department of Oncology, Cancer Centre of Southeastern Ontario, Queen's University, Kingston, ON, Canada (J.D.)
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Grewal RK, Chetty M, Abayomi EA, Tomuleasa C, Fromm JR. Use of flow cytometry in the phenotypic diagnosis of hodgkin's lymphoma. CYTOMETRY PART B-CLINICAL CYTOMETRY 2018; 96:116-127. [PMID: 30350336 DOI: 10.1002/cyto.b.21724] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/26/2018] [Revised: 06/18/2018] [Accepted: 06/26/2018] [Indexed: 12/22/2022]
Abstract
Hodgkin's lymphoma (HL) has a unique immunophenotype derived from immunohistochemistry (positive for CD15, CD30, and Pax-5; negative for CD3, CD20 in most cases, and CD45). The knowledge gained over recent years enables better diagnosis, prognosis, and treatment of HL. Flow cytometry as a tool for the diagnosis of classic HL has not been useful in the past due to the difficulty in isolating Reed-Sternberg cells as they are admixed in a rich inflammatory background which consists mainly of T cells, B cells, eosinophils, histiocytes, and plasma cells. However, in the recent past, several studies have tried to identify Reed-Sternberg cells using flow cytometry on fine needle aspiration or tissue biopsy of lymph nodes to confirm or supplement immunohistochemistry staining in diagnosis. Newer and more sensitive tools such as flow cytometry can be used for diagnosis, technology that may have been difficult in the past for diagnosis of this lymphoma subtype. Using flow cytometry, diagnosis is faster and could lead to point-of-care technology especially where we have typical immunophenotype signatures. © 2018 International Clinical Cytometry Society.
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Affiliation(s)
- Ravnit-Kaur Grewal
- MBCHB South African National Bioinformatics Institute, University of the Western Cape, Bellville, South Africa
| | - Manogari Chetty
- Department of Oral and Molecular Biology, Faculty of Dentistry, University of the Western Cape, Cape Town, South Africa
| | | | - Ciprian Tomuleasa
- Department of Hematology/Research Center for Functional Genomics and Translational Medicine, Iuliu Hatieganu University of Medicine and Pharmacy-Ion Chiricuta Oncology Institute, Cluj Napoca, Romania
| | - Jonathan R Fromm
- Department of Laboratory Medicine, University of Washington, Seattle, Washington
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Édeline V, Remouchamps V, Isnardi V, Vander Borght T. Multimodality imaging using PET/CT (18F)-fluorodeoxyglucose for radiotherapy field delineation of localized Hodgkin lymphoma. Cancer Radiother 2018; 22:384-392. [DOI: 10.1016/j.canrad.2018.07.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2018] [Accepted: 06/21/2018] [Indexed: 10/28/2022]
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Totadri S, Radhakrishnan V, Ganesan TS, Ganesan P, Kannan K, Lakshmipathy KM, Selvaluxmy G, Sagar TG. Can Radiotherapy Be Omitted in Children With Hodgkin Lymphoma Who Achieve Metabolic Remission on Interim Positron Emission Tomography? Experience of a Tertiary Care Cancer Referral Center. J Glob Oncol 2018; 4:1-7. [PMID: 30241201 PMCID: PMC6180840 DOI: 10.1200/jgo.2017.009340] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
PURPOSE Treating pediatric Hodgkin lymphoma (HL) involves a delicate balance between cure and reducing late toxicity. Fluorodeoxyglucose positron emission tomography (PET) combined with computed tomography (CT) identifies patients with early response to chemotherapy, for whom radiotherapy may be avoided. The role of PET-CT in upfront risk stratification and response-adapted treatment is evaluated in this study. METHODS Patients with HL, who were younger than 18 years, were included. PET-CT was performed at baseline and after two cycles of chemotherapy. Patients were stratified into three risk groups: group 1 (stage I or II with no unfavorable features); group 2 (stage I or II with bulky disease/B symptoms); and group 3 (stage III/IV). A doxorubicin, bleomycin, vinblastine, dacarbazine-based regimen was used in early disease. A cyclophosphamide, vincristine, prednisolone, procarbazine, doxorubicin, bleomycin, vinblastine-based regimen was used in advanced disease. RESULTS Forty-nine patients were included. Fifteen (31%), seven (14%), and 27 (55%) patients were included in groups 1, 2, and 3, respectively. Among 36 patients who underwent staging by PET-CT at diagnosis, seven (19%) patients were upstaged and one (3%) patient was downstaged by PET compared with CT. On the basis of negative interim PET responses, 39 (80%) patients were treated without radiotherapy. The 3-year event-free survival for the entire cohort was 91% (± 5.2%) and overall survival was 100%. CONCLUSION PET-CT is an excellent stand-alone staging modality in HL. The omission of radiotherapy can be considered in patients who achieve metabolic remission on interim PET.
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Rigacci L, Kovalchuk S, Berti V, Puccini B, Mannelli L, Benelli G, Dini C, Pupi A, Bosi A. The use of Deauville 5-point score could reduce the risk of false-positive fluorodeoxyglucose-positron emission tomography in the posttherapy evaluation of patients with primary bone lymphomas. World J Nucl Med 2018; 17:157-165. [PMID: 30034279 PMCID: PMC6034538 DOI: 10.4103/wjnm.wjnm_42_17] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Primary bone lymphoma (PBL) is a rare disease. Little is reported about response evaluation procedures in these patients. Our aim was to evaluate response to therapy according to fluorodeoxyglucose-positron emission tomography (FDG-PET) results, and in particular to test the Deauville 5-point scale as compared to the visual evaluation of FDG-PET scans in PBL. In this single-center study, we diagnosed 31 consecutive patients with PBL, of which 24 were evaluated with end-of-treatment FDG-PET. Patients' ages ranged from 19 to 82 years. Six patients were treated with chemotherapy, 24 with chemotherapy and radiotherapy, and one patient with radiotherapy alone. Six patients were affected by a pathological fracture. Four patients died within the range of 3 to 36 months after diagnosis. The average follow-up of the remaining patients was 70 (24–173) months. Overall survival was 87% at 5 years. The only positive prognostic factor was complete remission after chemotherapy. According to visual criteria, end-of-treatment FDG-PET was evaluated in 24 patients and it was positive in 11 (46%) and negative in 13 patients. We organized a retrospective central-blinded revision of end-of-therapy FDG-PET scans using the 5-point Deauville Score (DS). We reviewed 17 out of 24 patients and obtained the following results: at the end of therapy, 12 patients with DS score 2, three patients with DS score 3, one patient with DS score 4, and none with DS score 5. Considering that all the 24 patients achieved complete remission after treatment, visual interpretation produced 11/24 false-positive results, and DS interpretation produced 1/17 false-positive results, thus significantly reducing the number of false positives. In PBL, the final evaluation at the end of therapy with FDG-PET should be evaluated using Deauville 5-point scale in order to significantly reduce the risk of false-positive scans.
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Affiliation(s)
- Luigi Rigacci
- Department of Hematology, University of Florence, Florence, Italy
| | - Sofia Kovalchuk
- Department of Hematology, University of Florence, Florence, Italy
| | - Valentina Berti
- Department of Biomedical, Experimental and Clinical Sciences, Nuclear Medicine Unit, University of Florence, Florence, Italy
| | | | - Lara Mannelli
- Department of Hematology, University of Florence, Florence, Italy
| | - Gemma Benelli
- Department of Hematology, University of Florence, Florence, Italy
| | - Catia Dini
- Department of Radiology, AOU Careggi, Florence, Italy
| | - Alberto Pupi
- Department of Biomedical, Experimental and Clinical Sciences, Nuclear Medicine Unit, University of Florence, Florence, Italy
| | - Alberto Bosi
- Department of Hematology, University of Florence, Florence, Italy
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Berriolo-Riedinger A, Becker S, Casasnovas O, Vander Borght T, Édeline V. Role of FDG PET-CT in the treatment management of Hodgkin lymphoma. Cancer Radiother 2018; 22:393-400. [PMID: 30033076 DOI: 10.1016/j.canrad.2018.06.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2018] [Accepted: 06/21/2018] [Indexed: 12/29/2022]
Abstract
Fluorodeoxyglucose (FDG) positons emission tomography (PET)-computed tomography (CT) is used in many ways at baseline and during the treatment of patients with Hodgkin lymphoma. Many properties of the technique are used in the different steps of patient's management. Initial staging with PET-CT is more accurate than conventional imaging and PET-CT also became the gold standard imaging at the end of treatment with a negative PET-CT mandatory for reaching a complete remission. Early assessment of response by PET-CT is one of the most powerful prognostic factors for progression-free survival of patients with localized and advanced stages and allows guiding treatment. Conversely, previous studies showed that there is no role of FDG PET-CT for the patient's follow-up.
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Affiliation(s)
- A Berriolo-Riedinger
- Department of Nuclear Medicine, centre Georges-François-Leclerc, 1, rue du Pr-Marion, 21000 Dijon, France
| | - S Becker
- Department of Nuclear Medicine, centre Henri-Becquerel, 1, rue d'Amiens, 76038 Rouen, France
| | - O Casasnovas
- Department of Hematology, CHU F.-Mitterrand, 21000 Dijon, France; Inserm, UMR 1231, 21000 Dijon, France
| | - T Vander Borght
- Department Nuclear Medicine, CHU UCL Namur, site de Godinne, rue Dr-Gaston-Thérasse 1, 5530 Yvoir, Belgium; Namur Research Institute in Life Sciences (Narilis), rue de Bruxelles 61, 5000 Namur, Belgium
| | - V Édeline
- Department of Nuclear Medicine, hôpital René-Huguenin, institut Curie, 35, rue Dailly, 92210 Saint-Cloud, France.
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Tamayo P, Martín A, Díaz L, Cabrero M, García R, García-Talavera P, Caballero D. 18 F-FDG PET/CT in the clinical management of patients with lymphoma. Rev Esp Med Nucl Imagen Mol 2017. [DOI: 10.1016/j.remnie.2017.06.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Thanarajasingam G, Bennani-Baiti N, Thompson CA. PET-CT in Staging, Response Evaluation, and Surveillance of Lymphoma. Curr Treat Options Oncol 2017; 17:24. [PMID: 27032646 DOI: 10.1007/s11864-016-0399-z] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
OPINION STATEMENT Lymphoma represents a broad spectrum of diseases with diverse biology, clinical behavior, and imaging features. Functional imaging with 18-F-fluorodeoxyglucose (FDG)-positron emission tomography combined with computed tomography (PET-CT) is widely recognized as the most sensitive and specific imaging modality for patients with lymphoma and is used as part of staging, response evaluation, and surveillance in patients with Hodgkin (HL) and non-Hodgkin lymphoma (NHL). Recent efforts at standardizing the conduct and consensus interpretation of PET-CT have facilitated its use in patients on clinical studies and beyond. The role of PET-CT has been affirmed in some clinical situations, such as staging and end-of-treatment evaluation in Hodgkin lymphoma and diffuse large B cell lymphoma (DLBCL), and in the evaluation of aggressive transformation of an indolent lymphoma. However, the role of functional imaging in other histologies and clinical settings is not as clear given the higher rate of false positive results and the costs inherent to PET-CT. There is little evidence to suggest its utility or impact on outcome in most indolent lymphomas, or in the setting of post-treatment surveillance. In addition, there remains controversy about the value of PET-CT in early response assessment during active therapy, particularly in DLBCL. This review will evaluate the evidence surrounding the role of PET-CT in staging, response evaluation and surveillance of Hodgkin and non-Hodgkin lymphoma.
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Affiliation(s)
- Gita Thanarajasingam
- Division of Hematology, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA
| | - Nabila Bennani-Baiti
- Division of Hematology, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA
| | - Carrie A Thompson
- Division of Hematology, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA.
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Abstract
18-fluoro-2-deoxy-D-glucose (FDG) positron emission tomography (PET)/computed tomography (CT) is currently the most valuable imaging technique in Hodgkin lymphoma. Since its first use in lymphomas in the 1990s, it has become the gold standard in the staging and end-of-treatment remission assessment in patients with Hodgkin lymphoma. The possibility of using early (interim) PET during first-line therapy to evaluate chemosensitivity and thus personalize treatment at this stage holds great promise, and much attention is now being directed toward this goal. With high probability, it is believed that in the near future, the result of interim PET-CT would serve as a compass to optimize treatment. Also the role of PET in pre-transplant assessment is currently evolving. Much controversy surrounds the possibility of detecting relapse after completed treatment with the use of PET in surveillance in the absence of symptoms suggestive of recurrence and the results of published studies are rather discouraging because of low positive predictive value. This review presents current knowledge about the role of 18-FDG-PET/CT imaging at each point of management of patients with Hodgkin lymphoma.
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Tamayo P, Martín A, Díaz L, Cabrero M, García R, García-Talavera P, Caballero D. 18F-FDG PET/CT in the clinical management of patients with lymphoma. Rev Esp Med Nucl Imagen Mol 2017; 36:312-321. [PMID: 28483374 DOI: 10.1016/j.remn.2017.03.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2017] [Revised: 03/07/2017] [Accepted: 03/13/2017] [Indexed: 01/01/2023]
Abstract
The aim of this work was to review the current recommendations for staging and response assessment of patients with Hodgkin lymphoma (HL) and non-Hodgkin lymphoma (NHL) in routine clinical practice after chemotherapy and/or stem cell transplantation. A five-point scale (5-PS) from the First International Workshop on PET in Lymphoma in Deauville, France, in 2009, was recommended as the standard tool to score imaging to assess treatment response in patients with lymphoma using 18F-Fluorodeoxyglucose (FDG) PET/CT. Following the recommendations of the 11th and 12th International Conferences on Malignant Lymphoma held in Lugano (Switzerland), in 2011 and 2013, respectively, a consensus (the so-called Lugano Classification) was reached regarding the use of PET/CT for staging and response assessment in FDG-avid lymphomas. As a result, 18F-FDG PET/CT was formally incorporated into standard staging for FDG-avid lymphomas. A bone marrow biopsy is no longer indicated for the routine staging of HL and most diffuse large B-cell lymphomas. PET/CT will be used to assess response in FDG-avid histologies using the 5-point scale. The recent introduction of biological agents with immune mechanisms requires flexibility in interpretations of the Lugano criteria due to tumour flare or a pseudo-progression effect produced by these agents. Provisional criteria have been proposed (Lymphoma Response to Immunomodulatory Therapy Criteria) with the introduction of the term 'Indeterminate Response' in order to identify this phenomenon until confirmed as flare/pseudoprogression or true progression. All these recommendations will improve evaluations of patients with lymphoma, and allow comparison of results from clinical practice and trials.
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Affiliation(s)
- P Tamayo
- Servicio de Medicina Nuclear, Hospital Universitario de Salamanca, Salamanca, España; Instituto de Investigación Biomédica de Salamanca (IBSAL), Salamanca, España.
| | - A Martín
- Servicio de Hematología, Hospital Universitario de Salamanca, Salamanca, España; Instituto de Investigación Biomédica de Salamanca (IBSAL), Salamanca, España
| | - L Díaz
- Servicio de Medicina Nuclear, Hospital Universitario de Salamanca, Salamanca, España
| | - M Cabrero
- Servicio de Hematología, Hospital Universitario de Salamanca, Salamanca, España; Instituto de Investigación Biomédica de Salamanca (IBSAL), Salamanca, España
| | - R García
- Servicio de Hematología, Hospital Universitario de Salamanca, Salamanca, España; Instituto de Investigación Biomédica de Salamanca (IBSAL), Salamanca, España
| | - P García-Talavera
- Servicio de Medicina Nuclear, Hospital Universitario de Salamanca, Salamanca, España
| | - D Caballero
- Servicio de Hematología, Hospital Universitario de Salamanca, Salamanca, España; Instituto de Investigación Biomédica de Salamanca (IBSAL), Salamanca, España
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26
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Figura N, Flampouri S, Mendenhall NP, Morris CG, McCook B, Ozdemir S, Slayton W, Sandler E, Hoppe BS. Importance of baseline PET/CT imaging on radiation field design and relapse rates in patients with Hodgkin lymphoma. Adv Radiat Oncol 2017; 2:197-203. [PMID: 28740932 PMCID: PMC5514251 DOI: 10.1016/j.adro.2017.01.006] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2016] [Revised: 01/10/2017] [Accepted: 01/11/2017] [Indexed: 12/24/2022] Open
Abstract
PURPOSE This study analyzed the impact of pretreatment positron emission tomography/computed tomography (PET/CT) scans on involved site radiation therapy (ISRT) field design and pattern of relapse among patients with Hodgkin lymphoma (HL). METHODS AND MATERIALS Thirty-seven patients with stage I or II HL who received first-line chemotherapy followed by consolidative ISRT to all initial sites of disease were enrolled in an institutional review board-approved outcomes-tracking protocol between January 2009 and December 2014. Patients underwent standard-of-care follow-up. Relapse-free survival (RFS) was evaluated using a Kaplan-Meier analysis and cohort comparisons using a χ2 test. RESULTS Thirty-one patients underwent (PET/CT) scans before chemotherapy and 6 did not because of a lack of insurance (n = 2), inpatient chemotherapy administration (n = 2), scheduling conflicts (n = 1), and unknown reasons (n = 1). The median follow-up was 46 months, and the 4-year RFS rate was 92%. Patients without pretreatment PET imaging were more likely to experience disease relapse (4-year RFS, 97% vs. 67%; P = .001). Among the 6 patients who did not receive a baseline PET/CT scan, all 3 recurrences occurred in lymph node regions outside of, but immediately adjacent to, the radiation field. CONCLUSIONS Patients with stage I/II HL who receive ISRT without pretreatment PET/CT scans appear to have an increased risk for relapse in adjacent nodal stations just outside the radiation field. A larger cohort with a longer follow-up is needed to confirm these findings.
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Affiliation(s)
- Nick Figura
- Department of Radiation Oncology, University of Florida College of Medicine, Gainesville, Florida
| | - Stella Flampouri
- Department of Radiation Oncology, University of Florida College of Medicine, Gainesville, Florida
| | - Nancy P. Mendenhall
- Department of Radiation Oncology, University of Florida College of Medicine, Gainesville, Florida
| | - Christopher G. Morris
- Department of Radiation Oncology, University of Florida College of Medicine, Gainesville, Florida
| | - Barry McCook
- Department of Radiology, University of Florida College of Medicine, Jacksonville, Florida
| | - Savas Ozdemir
- Department of Radiology, University of Florida College of Medicine, Jacksonville, Florida
| | - William Slayton
- Division of Hematology & Oncology, University of Florida College of Medicine, Jacksonville, Florida
| | - Eric Sandler
- Nemours Children’s Specialty Care, Jacksonville, Florida
| | - Bradford S. Hoppe
- Department of Radiation Oncology, University of Florida College of Medicine, Gainesville, Florida
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Kluge R, Kurch L, Georgi T, Metzger M. Current Role of FDG-PET in Pediatric Hodgkin's Lymphoma. Semin Nucl Med 2017; 47:242-257. [PMID: 28417854 DOI: 10.1053/j.semnuclmed.2017.01.001] [Citation(s) in RCA: 42] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Hodgkin's lymphoma is one of the most curable pediatric cancers with long-term survival rates exceeding 90% following intensive treatment. Collaborative group studies worldwide aim on reduction or elimination of radiotherapy to avoid potentially life-limiting late effects especially second cancers and cardiovascular diseases. Large prospective trials have integrated early response FDG-PET scans to identify adequate responders to chemotherapy in whom radiotherapy may safely be omitted. The criteria for interpretation of early response PET have changed during the past years and will be further refined based on trial results. FDG-PET is also systematically used to assess initial disease involvement of pediatric Hodgkin's lymphoma and could replace bone marrow biopsy. This article summarizes the role of FDG-PET in staging and response assessment focusing on large pediatric trials, the criteria for PET interpretation and pitfalls.
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Affiliation(s)
- Regine Kluge
- Department of Nuclear Medicine, University Hospital of Leipzig, Leipzig, Germany.
| | - L Kurch
- Department of Nuclear Medicine, University Hospital of Leipzig, Leipzig, Germany
| | - Thomas Georgi
- Department of Nuclear Medicine, University Hospital of Leipzig, Leipzig, Germany
| | - Monika Metzger
- Department of Oncology, St. Jude Children's Research Hospital, Memphis, TN
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28
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Barrington SF, Kirkwood AA, Franceschetto A, Fulham MJ, Roberts TH, Almquist H, Brun E, Hjorthaug K, Viney ZN, Pike LC, Federico M, Luminari S, Radford J, Trotman J, Fosså A, Berkahn L, Molin D, D'Amore F, Sinclair DA, Smith P, O'Doherty MJ, Stevens L, Johnson PW. PET-CT for staging and early response: results from the Response-Adapted Therapy in Advanced Hodgkin Lymphoma study. Blood 2016; 127:1531-8. [PMID: 26747247 DOI: 10.1182/blood-2015-11-679407] [Citation(s) in RCA: 106] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2015] [Accepted: 12/26/2015] [Indexed: 02/01/2023] Open
Abstract
International guidelines recommend that positron emission tomography-computed tomography (PET-CT) should replace CT in Hodgkin lymphoma (HL). The aims of this study were to compare PET-CT with CT for staging and measure agreement between expert and local readers, using a 5-point scale (Deauville criteria), to adapt treatment in a clinical trial: Response-Adapted Therapy in Advanced Hodgkin Lymphoma (RATHL). Patients were staged using clinical assessment, CT, and bone marrow biopsy (RATHL stage). PET-CT was performed at baseline (PET0) and after 2 chemotherapy cycles (PET2) in a response-adapted design. PET-CT was reported centrally by experts at 5 national core laboratories. Local readers optionally scored PET2 scans. The RATHL and PET-CT stages were compared. Agreement among experts and between expert and local readers was measured. RATHL and PET0 stage were concordant in 938 (80%) patients. PET-CT upstaged 159 (14%) and downstaged 74 (6%) patients. Upstaging by extranodal disease in bone marrow (92), lung (11), or multiple sites (12) on PET-CT accounted for most discrepancies. Follow-up of discrepant findings confirmed the PET characterization of lesions in the vast majority. Five patients were upstaged by marrow biopsy and 7 by contrast-enhanced CT in the bowel and/or liver or spleen. PET2 agreement among experts (140 scans) with a κ (95% confidence interval) of 0.84 (0.76-0.91) was very good and between experts and local readers (300 scans) at 0.77 (0.68-0.86) was good. These results confirm PET-CT as the modern standard for staging HL and that response assessment using Deauville criteria is robust, enabling translation of RATHL results into clinical practice.
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Affiliation(s)
- Sally F Barrington
- PET Imaging Centre, Division of Imaging Sciences and Biomedical Engineering, King's College London, King's Health Partners, St. Thomas' Hospital, London, United Kingdom
| | - Amy A Kirkwood
- Cancer Research UK and UCL Cancer Trials Centre, London, United Kingdom
| | | | - Michael J Fulham
- Department of Molecular Imaging (PET-CT), Royal Prince Alfred Hospital, Sydney, Australia; Sydney Medical School, University of Sydney, Sydney, Australia
| | - Thomas H Roberts
- Cancer Research UK and UCL Cancer Trials Centre, London, United Kingdom
| | | | - Eva Brun
- Department of Oncology and Radiation Physics, Skane University Hospital, Lund University, Lund, Sweden
| | - Karin Hjorthaug
- Department of Nuclear Medicine & PET Centre, Aarhus University Hospital, Aarhus, Denmark
| | - Zaid N Viney
- Department of Radiology, Guy's and St. Thomas' National Health Service (NHS) Foundation Trust, London, United Kingdom
| | - Lucy C Pike
- PET Imaging Centre, Division of Imaging Sciences and Biomedical Engineering, King's College London, King's Health Partners, St. Thomas' Hospital, London, United Kingdom
| | - Massimo Federico
- Oncology Unit, Department of Diagnostic, Clinical and Public Health Medicine, University of Modena and Reggio Emilia, Modena, Italy
| | - Stefano Luminari
- Oncology Unit, Department of Diagnostic, Clinical and Public Health Medicine, University of Modena and Reggio Emilia, Modena, Italy
| | - John Radford
- The University of Manchester and the Christie NHS Foundation Trust, Manchester, United Kingdom
| | - Judith Trotman
- Sydney Medical School, University of Sydney, Sydney, Australia; Concord, Repatriation General Hospital, Sydney, Australia
| | - Alexander Fosså
- Department of Oncology, Norwegian Radium Hospital, Oslo, Norway
| | - Leanne Berkahn
- Haematology, Auckland City Hospital, Auckland, New Zealand
| | - Daniel Molin
- Department of Genetics and Pathology, Experimental and Clinical Oncology, Uppsala University, Uppsala, Sweden
| | | | - Donald A Sinclair
- PET Imaging Centre, Division of Imaging Sciences and Biomedical Engineering, King's College London, King's Health Partners, St. Thomas' Hospital, London, United Kingdom
| | - Paul Smith
- Cancer Research UK and UCL Cancer Trials Centre, London, United Kingdom
| | - Michael J O'Doherty
- PET Imaging Centre, Division of Imaging Sciences and Biomedical Engineering, King's College London, King's Health Partners, St. Thomas' Hospital, London, United Kingdom
| | - Lindsey Stevens
- Cancer Research UK and UCL Cancer Trials Centre, London, United Kingdom
| | - Peter W Johnson
- Cancer Research UK Centre, University of Southampton, Southampton, United Kingdom
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Abstract
With the introduction of hybrid imaging technologies such as PET/CT and recently PET/MRI, staging and therapy-response monitoring have evolved. PET/CT has been shown to be of value for routine staging of FDG-avid lymphomas before as well as at the end of treatment. For interim staging, trials are ongoing to evaluate the use of PET/CT. In melanoma, PET/CT can be recommended for stages III and IV diseases for initial staging and before surgery. Studies investigating the use of PET/CT for early therapy response are promising. The role of PET/MR in lymphoma and melanoma imaging has to be defined because no larger studies exist so far. There may be an application of PET/MR in research especially for tumor characterization and therapy response. Furthermore, the potential role of non-FDG tracers is elucidated regarding the assessment of treatment response in targeted drug regimens.
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Affiliation(s)
- Nina F Schwenzer
- Department of Radiology, Diagnostic and Interventional Radiology, Eberhard Karls University Tübingen, Tübingen, Germany.
| | - Anna Christina Pfannenberg
- Department of Radiology, Diagnostic and Interventional Radiology, Eberhard Karls University Tübingen, Tübingen, Germany
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30
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Barrington SF, Mikhaeel NG, Kostakoglu L, Meignan M, Hutchings M, Müeller SP, Schwartz LH, Zucca E, Fisher RI, Trotman J, Hoekstra OS, Hicks RJ, O'Doherty MJ, Hustinx R, Biggi A, Cheson BD. Role of imaging in the staging and response assessment of lymphoma: consensus of the International Conference on Malignant Lymphomas Imaging Working Group. J Clin Oncol 2015; 32:3048-58. [PMID: 25113771 DOI: 10.1200/jco.2013.53.5229] [Citation(s) in RCA: 1062] [Impact Index Per Article: 118.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
PURPOSE Recent advances in imaging, use of prognostic indices, and molecular profiling techniques have the potential to improve disease characterization and outcomes in lymphoma. International trials are under way to test image-based response–adapted treatment guided by early interim positron emission tomography (PET)–computed tomography (CT). Progress in imaging is influencing trial design and affecting clinical practice. In particular, a five-point scale to grade response using PET-CT, which can be adapted to suit requirements for early- and late-response assessment with good interobserver agreement, is becoming widely used both in practice- and response-adapted trials. A workshop held at the 11th International Conference on Malignant Lymphomas (ICML) in 2011 concluded that revision to current staging and response criteria was timely. METHODS An imaging working group composed of representatives from major international cooperative groups was asked to review the literature, share knowledge about research in progress, and identify key areas for research pertaining to imaging and lymphoma. RESULTS A working paper was circulated for comment and presented at the Fourth International Workshop on PET in Lymphoma in Menton, France, and the 12th ICML in Lugano, Switzerland, to update the International Harmonisation Project guidance regarding PET. Recommendations were made to optimize the use of PET-CT in staging and response assessment of lymphoma, including qualitative and quantitative methods. CONCLUSION This article comprises the consensus reached to update guidance on the use of PET-CT for staging and response assessment for [18F]fluorodeoxyglucose-avid lymphomas in clinical practice and late-phase trials.
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Chen B, Han D, Ge BH, Li C, Ma D, Yang J. RETRACTED ARTICLE: The diagnostic performance of 18F-FDG PET in detecting bone marrow infiltration in Hodgkin's lymphoma and diffuse large B-cell lymphoma: a meta-analysis. Skeletal Radiol 2015; 44:311. [PMID: 25194939 DOI: 10.1007/s00256-014-1995-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2014] [Revised: 05/18/2014] [Accepted: 08/19/2014] [Indexed: 02/02/2023]
Affiliation(s)
- Budong Chen
- Radiology Department, Beijing Friendship Hospital of Capital Medical University, Beijing, 100050, China
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32
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Abstract
The role of PET and PET/computed tomography (CT) has evolved significantly in the last few decades. 2-Deoxy-2-[18F]-fluoro-d-glucose (FDG)-PET/CT is now an integral part of the management of patients with lymphoma. FDG-PET/CT at the time of initial staging can help in appropriate staging of the patients. Both interim and end-of-therapy PETs have significant prognostic value in patients with Hodgkin lymphoma and aggressive non-Hodgkin lymphoma and more accurately assess for the presence of residual malignancy than anatomic imaging. The impact of interim FDG-PET/CT on risk-adapted strategies is an area of active investigation and the results of ongoing clinical trials will be informative.
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33
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Gallamini A, Hutchings M, Borra A. Functional Imaging in Hodgkin Lymphoma. HODGKIN LYMPHOMA 2015. [DOI: 10.1007/978-3-319-12505-3_7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
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Gallamini A, Zwarthoed C, Borra A. Positron Emission Tomography (PET) in Oncology. Cancers (Basel) 2014; 6:1821-89. [PMID: 25268160 PMCID: PMC4276948 DOI: 10.3390/cancers6041821] [Citation(s) in RCA: 203] [Impact Index Per Article: 20.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2014] [Revised: 07/25/2014] [Accepted: 08/07/2014] [Indexed: 02/07/2023] Open
Abstract
Since its introduction in the early nineties as a promising functional imaging technique in the management of neoplastic disorders, FDG-PET, and subsequently FDG-PET/CT, has become a cornerstone in several oncologic procedures such as tumor staging and restaging, treatment efficacy assessment during or after treatment end and radiotherapy planning. Moreover, the continuous technological progress of image generation and the introduction of sophisticated software to use PET scan as a biomarker paved the way to calculate new prognostic markers such as the metabolic tumor volume (MTV) and the total amount of tumor glycolysis (TLG). FDG-PET/CT proved more sensitive than contrast-enhanced CT scan in staging of several type of lymphoma or in detecting widespread tumor dissemination in several solid cancers, such as breast, lung, colon, ovary and head and neck carcinoma. As a consequence the stage of patients was upgraded, with a change of treatment in 10%-15% of them. One of the most evident advantages of FDG-PET was its ability to detect, very early during treatment, significant changes in glucose metabolism or even complete shutoff of the neoplastic cell metabolism as a surrogate of tumor chemosensitivity assessment. This could enable clinicians to detect much earlier the effectiveness of a given antineoplastic treatment, as compared to the traditional radiological detection of tumor shrinkage, which usually takes time and occurs much later.
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Affiliation(s)
- Andrea Gallamini
- Department of Research and Medical Innovation, Antoine Lacassagne Cancer Center, Nice University, Nice Cedex 2-06189 Nice, France.
| | - Colette Zwarthoed
- Department of Nuclear Medicine, Antoine Lacassagne Cancer Center, Nice University, Nice Cedex 2-06189 Nice, France.
| | - Anna Borra
- Hematology Department S. Croce Hospital, Via M. Coppino 26, Cuneo 12100, Italy.
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35
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Bednaruk-Młyński E, Pieńkowska J, Skórzak A, Małkowski B, Kulikowski W, Subocz E, Dzietczenia J, Zalewska M, Leśniewski-Kmak K, Zaucha R, Wróbel T, Zaucha JM. Comparison of positron emission tomography/computed tomography with classical contrast-enhanced computed tomography in the initial staging of Hodgkin lymphoma. Leuk Lymphoma 2014; 56:377-82. [PMID: 24794802 DOI: 10.3109/10428194.2014.919635] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
We compared initial computed tomography (CT) and positron emission tomography (PET)/CT in 96 patients with Hodgkin lymphoma (HL), assessing the role of baseline PET/CT in stage migration and treatment selection. The number of patients with stage I, II, III and IV disease based on CT versus PET/CT was: 5 vs. 7, 49 vs. 37, 28 vs. 22 and 14 vs. 30, respectively. In 33 (34%) patients, PET/CT changed HL stage: 27 (28%) were upstaged and six (6.3%) downstaged. Upstaging was caused by detection of new extranodal involvements (47 sites in 26 patients): bone marrow (10 patients), spleen (five patients) and lung (two patients). In nine patients≥2 further coexisting locations were detected. Downstaging resulted from the absence of fluorodeoxyglucose (18F-FDG) uptake in enlarged nodes (>15 mm) in the abdomen and pelvis. PET/CT modified HL stage in 34% of patients leading to treatment modification in the majority. Our results indicate that PET/CT should be mandatory in the initial staging of HL.
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Affiliation(s)
- Ewa Bednaruk-Młyński
- Department of Oncology and Radiotherapy, Medical University of Gdansk , Gdansk , Poland
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37
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Kostakoglu L, Cheson BD. Current role of FDG PET/CT in lymphoma. Eur J Nucl Med Mol Imaging 2014; 41:1004-27. [PMID: 24519556 DOI: 10.1007/s00259-013-2686-2] [Citation(s) in RCA: 52] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2013] [Accepted: 12/27/2013] [Indexed: 01/08/2023]
Abstract
The management approach in Hodgkin's (HL) and high-grade non-Hodgkin's lymphomas (NHL) has shifted towards reducing the toxicity and long-term adverse effects associated with treatment while maintaining favorable outcomes in low-risk patients. The success of an individualized treatment strategy depends largely on accurate diagnostic tests both at staging and during therapy. In this regard, positron emission tomography (PET) using fluorodeoxyglucose (FDG) with computed tomography (CT) has proved effective as a metabolic imaging tool with compelling evidence supporting its superiority over conventional modalities, particularly in staging and early evaluation of response. Eventually, this modality was integrated into the routine staging and restaging algorithm of lymphomas. This review will summarize the data on the proven and potential utility of PET/CT imaging for staging, response assessment, and restaging, describing current limitations of this imaging modality.
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Affiliation(s)
- Lale Kostakoglu
- Department of Radiology, Icahn School of Medicine at Mount Sinai, One Gustave Levy Place, Box 1141, New York, NY, 10029, USA,
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38
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Kobe C, Dietlein M, Kriz J, Furth C, Fuchs M, Borchmann P, Engert A, Eich HT. The role of PET in Hodgkin’s lymphoma and its impact on radiation oncology. Expert Rev Anticancer Ther 2014; 10:1419-28. [DOI: 10.1586/era.10.114] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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39
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Kostakoglu L, Cheson BD. State-of-the-Art Research on "Lymphomas: Role of Molecular Imaging for Staging, Prognostic Evaluation, and Treatment Response". Front Oncol 2013; 3:212. [PMID: 24027671 PMCID: PMC3762124 DOI: 10.3389/fonc.2013.00212] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2013] [Accepted: 08/02/2013] [Indexed: 12/11/2022] Open
Abstract
Lymphomas are heterogeneous but potentially curable group of neoplasms. Treatment of lymphomas has rapidly evolved overtime with significant improvement in the cure rate and reductions in treatment-related toxicities. Despite excellent results, treatment programs are continued to be developed to achieve better curative and safety profiles. In these patients individualized therapy schemes can be devised based on a well-defined risk categorization. The therapy efficacy can be increased early during therapy in non-responding patients with escalated therapy protocols or with the addition of radiation therapy, particularly, in advanced-stage or unfavorable risk patients. The increasing availability of positron emission tomography using 18F-fluorodeoxyglucose, particularly fused with computed tomography (FDG-PET/CT) has lead to the integration of this modality into the routine staging and restaging for lymphoma with convincing evidence that it is a more accurate imaging modality compared with conventional imaging techniques. FDG-PET/CT is also is a promising surrogate for tumor chemosensitivity early during therapy. This review will summarize published data on the utility of FDG-PET/CT imaging in the staging, restaging, and predicting therapy response in patients with lymphoma.
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Affiliation(s)
- Lale Kostakoglu
- Department of Radiology, Mount Sinai Medical Center , New York, NY , USA
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40
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Value of 18F-FDG PET versus iliac biopsy in the initial evaluation of bone marrow infiltration in the case of Hodgkin's disease: a meta-analysis. Nucl Med Commun 2013; 34:25-31. [PMID: 23111383 DOI: 10.1097/mnm.0b013e32835afc19] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
OBJECTIVE We carried out a meta-analysis to evaluate the performance of 2-deoxy-2-[(18)F]fluoro-D-glucose ((18)F-FDG) PET and PET/CT against bone marrow biopsy (BMB) in the initial diagnosis of bone marrow infiltration (BMI) in patients with Hodgkin's disease (HD). MATERIALS AND METHODS Retrospective and prospective studies with direct comparison of (18)F-FDG PET with BMB in the initial evaluation of BMI in HD were included. Seven eligible studies were included in the meta-analysis comprising a total of 687 patients. RESULTS Both (18)F-FDG PET and BMB had excellent specificity in detecting BMI. However, (18)F-FDG PET had excellent pooled sensitivity (94.5%; 95% confidence interval: 89.0-97.8%) in detecting BMI in the initial staging of HD patients, whereas the pooled sensitivity of iliac BMB was very poor (39.4%; 95% confidence interval: 30.8-48.4%). The diagnostic odds ratio, a measure of the overall diagnostic power of the test, was much higher for PET (pooled value of 1591) than for iliac BMB (pooled value of 137). CONCLUSION (18)F-FDG PET significantly outperforms iliac BMB in the detection of BMI in the initial staging of HD patients and therefore should be used as a first-line study. Iliac BMB has low sensitivity and a high rate of false-negative findings. Thus, a negative BMB finding cannot rule out marrow involvement in HD patients on initial staging.
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41
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Abstract
The aim of this review is to give an overview of FDG PET/CT applications in children and adolescents with lymphoma. Today, FDG PET is used for tailoring treatment intensity in children with Hodgkin lymphoma within the framework of international treatment optimisation protocols. In contrast, the role of this method in children with Non-Hodgkin lymphoma is not well defined. This paper overviews clinical appearance and metabolic behaviour of the most frequent lymphoma subtypes in childhood. The main focus of the review is to summarise knowledge about the role of FDG PET/CT for initial staging and early response assessment.
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42
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Guignard R, Zwarthoed C, Borra A, Darcourt J, Gallamini A. PET scan integration in lymphoma management. Int J Hematol Oncol 2013. [DOI: 10.2217/ijh.13.11] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
SUMMARY Despite a marked improvement in lymphoma treatment outcome, current prognostic models, relying on a pretreatment set of static clinical variables, appear unable to support a risk-adapted therapeutic strategy. On the other hand, functional imaging with 18F-fluoro-2-deoxy-D-glucose (FDG)-PET proved to be a reliable tool to dynamically assess tumor FDG uptake changes during and after treatment. In this article we aim to review the prognostic value of FDG-PET in all the stages of Hodgkin’s and non-Hodgkin’s lymphoma management, without the intent to address the diagnostic value of PET or to replace available consensus guidelines. In particular we focused on two critical issues: the cost–effectiveness of PET in the overall strategy of lymphoma diagnosis and treatment; and ongoing clinical trials adopting an interim PET-based strategy to modulate treatment intensity based on PET results. Finally, new trends in multimodality imaging, as well as in new radiopharmaceutical tracers, are briefly reviewed.
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Affiliation(s)
- Renaud Guignard
- Nuclear Medicine Department, 33 Avenue Valombrose, 06189 Nice Cedex 2, Centre Antoine Lacassagne, Nice, France.
| | - Colette Zwarthoed
- Nuclear Medicine Department, 33 Avenue Valombrose, 06189 Nice Cedex 2, Centre Antoine Lacassagne, Nice, France
| | - Anna Borra
- Hematology Department, Centre Antoine Lacassagne, Nice, France
| | - Jacques Darcourt
- Nuclear Medicine Department, 33 Avenue Valombrose, 06189 Nice Cedex 2, Centre Antoine Lacassagne, Nice, France
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Pilkington Woll J, García Vicente A, Talavera Rubio M, Palomar Muñoz A, Jiménez Londoño G, León Martín A, Calle Primo C, Soriano Castejón A. Quantitative and qualitative evaluation of the interim PET/CT in lymphoma treatment in the prediction of complete metabolic response. Rev Esp Med Nucl Imagen Mol 2013. [DOI: 10.1016/j.remnie.2013.01.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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44
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Gobbi PG, Ferreri AJ, Ponzoni M, Levis A. Hodgkin lymphoma. Crit Rev Oncol Hematol 2013; 85:216-37. [DOI: 10.1016/j.critrevonc.2012.07.002] [Citation(s) in RCA: 56] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2011] [Revised: 03/02/2012] [Accepted: 07/03/2012] [Indexed: 10/28/2022] Open
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Cortez AJP, Dulley FL, Saboya R, Mendrone Júnior A, Amigo Filho U, Coracin FL, Buccheri V, Linardi CDCG, Ruiz MA, Chamone DDAF. Autologous hematopoietic stem cell transplantation in classical Hodgkin's lymphoma. Rev Bras Hematol Hemoter 2013; 33:10-4. [PMID: 23284236 PMCID: PMC3521428 DOI: 10.5581/1516-8484.20110007] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2010] [Accepted: 12/11/2010] [Indexed: 11/30/2022] Open
Abstract
Background Hodgkin's lymphoma has high rates of cure, but in 15% to 20% of general patients and between 35% and 40% of those in advanced stages, the disease will progress or will relapse after initial treatment. For this group, hematopoietic stem cell transplantation is considered one option of salvage therapy. Objectives To evaluate a group of 106 patients with Hodgkin's lymphoma, who suffered relapse or who were refractory to treatment, submitted to autologous hematopoietic stem cell transplantation in a single transplant center. Methods A retrospective study was performed with data collected from patient charts. The analysis involved 106 classical Hodgkin's lymphoma patients who were consecutively submitted to high-dose chemotherapy followed by autologous transplants in a single institution from April 1993 to December 2006. Results The overall survival rates of this population at five and ten years were 86% and 70%, respectively. The disease-free survival was approximately 60% at five years. Four patients died of procedure-related causes but relapse of classical Hodgkin's lymphoma after transplant was the most frequent cause of death. Univariate analysis shows that sensitivity to pre-transplant treatment and hemoglobin < 10 g/dL at diagnosis had an impact on patient survival. Unlike other studies, B-type symptoms did not seem to affect overall survival. Lactic dehydrogenase and serum albumin concentrations analyzed at diagnosis did not influence patient survival either. Conclusion Autologous hematopoietic stem cell transplantation is an effective treatment strategy for early and late relapse in classical Hodgkin's lymphoma for cases that were responsive to pre-transplant chemotherapy. Refractory to treatment is a sign of worse prognosis. Additionally, a hemoglobin concentration below 10 g/dL at diagnosis of Hodgkin's lymphoma has a negative impact on the survival of patients after transplant. As far as we know this relationship has not been previously reported.
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El-Galaly TC, d'Amore F, Mylam KJ, de Nully Brown P, Bøgsted M, Bukh A, Specht L, Loft A, Iyer V, Hjorthaug K, Nielsen AL, Christiansen I, Madsen C, Johnsen HE, Hutchings M. Routine bone marrow biopsy has little or no therapeutic consequence for positron emission tomography/computed tomography-staged treatment-naive patients with Hodgkin lymphoma. J Clin Oncol 2012; 30:4508-14. [PMID: 23150698 DOI: 10.1200/jco.2012.42.4036] [Citation(s) in RCA: 173] [Impact Index Per Article: 14.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE To investigate whether bone marrow biopsy (BMB) adds useful information to [(18)F]fluorodeoxyglucose (FDG) positron emission tomography/computed tomography (PET/CT) staging in patients with Hodgkin lymphoma (HL). PATIENTS AND METHODS Newly diagnosed patients with HL undergoing a pretherapeutic staging that encompasses both PET/CT and BMB were included in this retrospective study. The pattern of skeletal FDG uptake was categorized as uni-, bi-, or multifocal (≥ three lesions). Clinical stage, risk assessment, and treatment plan were determined with and without the contribution of BMB results according to the Ann Arbor classification and the guidelines from the German Hodgkin Study Group. RESULTS A total of 454 patients with HL were included of whom 82 (18%) had focal skeletal PET/CT lesions and 27 (6%) had positive BMB. No patients with positive BMB were assessed as having stage I to II disease by PET/CT staging. BMB upstaged five patients, assessed as being stage III before BMB; none of the 454 patients would have been allocated to another treatment on the basis of BMB results. Focal skeletal PET/CT lesions identified positive and negative BMBs with a sensitivity and specificity of 85% and 86%, respectively. The positive and negative predictive values of focal skeletal PET/CT lesions for BMB results were 28% and 99%, respectively. CONCLUSION A consistent finding of this study was the absence of positive BMBs in PET/CT-assessed stage I to II disease. The omission of staging BMB would not have changed the risk assessment or treatment strategy in this cohort of 454 newly diagnosed patients with HL.
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Akin O, Brennan SB, Dershaw DD, Ginsberg MS, Gollub MJ, Schöder H, Panicek DM, Hricak H. Advances in oncologic imaging: update on 5 common cancers. CA Cancer J Clin 2012; 62:364-93. [PMID: 23070605 DOI: 10.3322/caac.21156] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Imaging has become a pivotal component throughout a patient's encounter with cancer, from initial disease detection and characterization through treatment response assessment and posttreatment follow-up. Recent progress in imaging technology has presented new opportunities for improving clinical care. This article provides updates on the latest approaches to imaging of 5 common cancers: breast, lung, prostate, and colorectal cancers, and lymphoma.
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Affiliation(s)
- Oguz Akin
- Weill Medical College of Cornell University, Memorial Hospital for Cancer and Allied Diseases, New York, NY, USA
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Abstract
Management of Hodgkin's lymphoma continues to develop. Outcomes for patients with favourable-risk, early-stage disease are excellent, and serial reductions in intensity of treatment have been made to retain the excellent prognosis while reducing the late effects of treatment. Prognosis is also very good in advanced-stage disease but the rate of relapse is higher than in early-stage disease, and the optimum first-line treatment is unclear. Workers are investigating the role of functional imaging to assess whether treatment can be tailored according to response, with the most intensive therapies reserved for patients predicted to have poor outcomes. In this Seminar we critically appraise the management of Hodgkin's lymphoma in early-stage disease, advanced-stage disease, and at relapse, with a focus on late effects of treatment.
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Affiliation(s)
- William Townsend
- Department of Haematology, University College London Medical School, Cancer Institute, UK
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Pilkington Woll JP, García Vicente AM, Talavera Rubio MP, Palomar Muñoz AM, Jiménez Londoño G, León Martín A, Calle Primo C, Soriano Castejón AM. [Quantitative and qualitative evaluation of the interim PET/CT in lymphoma treatment in the prediction of complete metabolic response]. Rev Esp Med Nucl Imagen Mol 2012; 32:70-6. [PMID: 22759992 DOI: 10.1016/j.remn.2012.03.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2012] [Revised: 03/08/2012] [Accepted: 03/09/2012] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To compare two different methods for the interpretation of interim PET/CT (PET/CT-i) in lymphomas, and to establish which one best predicts a complete metabolic response (CMR) in the PET/CT study at the end of treatment (PET/CT-et). MATERIAL AND METHODS Retrospective longitudinal analysis of the PET/CT studies for staging (PET/CT-s), PET/CT-i and PET/CT-et of 65 patients, 35 Hodgkin's lymphoma (HL) and 30 Non-HL. The PET/CT-i was performed between the second and fourth chemotherapy cycle. It was interpreted using two different criteria: qualitative criteria (5 point visual scale), semiquantitative criteria (percentage difference between the lesion with more SUVmax in the PET/CT-s and PET/CT-i). We analyzed the likelihood of obtaining a CMR in the PET/CT-et according to the results obtained on the PET/CT-i with these two criteria. RESULTS We obtained sensitivity (S), specificity (Sp), positive predictive values (PPV), negative predictive values (NPV) and likelihood ratio (LR) for the qualitative/semiquantitative method of 91%/80%, 76.2%/67%, 88.9%/83.3%, 80%/60.9% and 32%/7.8%, respectively, to predict a CMR in the PET/CT-et. There were no statistically significant differences between the LR of both methods (p=0.1942). CONCLUSION We found clear differences in S, Sp, PPV and NPV between both interpretation criteria for the PET/CT-i to predict a CMR in the PET/CT-et. Nevertheless, we cannot confirm the superiority of the qualitative method over the semiqualitative method for this purpose as no statistically significance differences were found in their LR in our study.
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Affiliation(s)
- J P Pilkington Woll
- Servicio de Medicina Nuclear, Hospital General Universitario de Ciudad Real, Ciudad Real, España.
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