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Czibor S, Carr R, Redondo F, Auewarakul CU, Cerci JJ, Paez D, Fanti S, Györke T. Prognostic parameters on baseline and interim [ 18 F]FDG-PET/computed tomography in diffuse large B-cell lymphoma patients. Nucl Med Commun 2023; 44:291-301. [PMID: 36705233 PMCID: PMC9994851 DOI: 10.1097/mnm.0000000000001664] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
OBJECTIVE 2-[ 18 F]fluoro-2-deoxy- d -glucose PET/computed tomography ([ 18 F]FDG-PET/CT) is a widely used imaging method in the management of diffuse large B-cell lymphomas (DLBCL). Our aim was to investigate the prognostic performance of different PET biomarkers in a multicenter setting. METHODS We investigated baseline volumetric values [metabolic tumor volume (MTV) and total lesion glycolysis (TLG), also normalized for body weight] segmented with three different methods [>SUV4 (glob4); 41% isocontour (41pc), and a gradient-based lesion growing algorithm (grad)] and interim parameters [Deauville score, maximal standardized uptake value (ΔSUVmax), modified qPET, and ratio PET (rPET)] alongside clinical parameters (stage, revised International Prognostic Index), using 24-month progression-free survival as the clinical endpoint. Receiver operating characteristics analyses were performed to define optimal cutoff points for the continuous PET parameters. RESULTS A total of 107 diffuse large B-cell lymphoma patients were included (54 women; mean age: 53.7 years). MTV and TLG calculations showed good correlation among glob4, 41pc, and grad methods; however, optimal cutoff points were markedly different.Significantly different PFS was observed between low- and high-risk groups according to baseline MTV, body weight-adjusted (bwa) MTV, TLG, bwaTLG, as well as interim parameters Deauville score, ΔSUVmax, mqPET, and rPET. Univariate Cox regression analyses showed hazard ratios (HRs) lowest for bwaMTVglob4 (HR = 2.3) and highest for rPET (HR = 9.09). In a multivariate Cox-regression model, rPET was shown to be an independent predictor of PFS ( P = 0.041; HR = 9.15). Combined analysis showed that ΔSUVmax positive patients with high MTV formed a group with distinctly poor PFS (35.3%). CONCLUSION Baseline MTV and TLG values and optimal cutoff points achieved with different segmentation methods varied markedly and showed a limited prognostic impact. Interim PET/CT parameters provided more accurate prognostic information with semiquantitative 'Deauville-like' parameters performing best in the present study.
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Affiliation(s)
- Sándor Czibor
- Department of Nuclear Medicine, Medical Imaging Centre, Semmelweis University, Budapest, Hungary
| | - Robert Carr
- Department of Hematology, Guy's and St. Thomas' Hospital, King's College London, London, UK
| | | | - Chirayu U Auewarakul
- Faculty of Medicine and Public Health, HRH Princess Chulabhorn College of Medical Science, Chulabhorn Royal Academy, Bangkok, Thailand
| | - Juliano J Cerci
- PET/CT Department at Quanta Diagnóstico e Terapia, Curitiba, Brazil
| | - Diana Paez
- Nuclear Medicine and Diagnostic Imaging Section, Division of Human Health, Department of Nuclear Sciences and Application, International Atomic Energy Agency, Vienna, Austria
| | - Stefano Fanti
- Metropolitan Nuclear Medicine, Policlinico S. Orsola, University of Bologna, Bologna, Italy
| | - Tamás Györke
- Department of Nuclear Medicine, Medical Imaging Centre, Semmelweis University, Budapest, Hungary
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Large B-cell lymphoma with IRF4 rearrangement: a special tonsillar lymphoma in children. PEDIATRIC HEMATOLOGY ONCOLOGY JOURNAL 2019. [DOI: 10.1016/j.phoj.2019.12.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
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Guo B, Tan X, Ke Q, Cen H. Prognostic value of baseline metabolic tumor volume and total lesion glycolysis in patients with lymphoma: A meta-analysis. PLoS One 2019; 14:e0210224. [PMID: 30625203 PMCID: PMC6326501 DOI: 10.1371/journal.pone.0210224] [Citation(s) in RCA: 65] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2018] [Accepted: 12/17/2018] [Indexed: 01/11/2023] Open
Abstract
Whether baseline metabolic tumor volume (TMTV) and total lesion glycolysis (TLG) measured by FDG-PET/CT affected prognosis of patients with lymphoma was controversial. We searched PubMed, EMBASE and Cochrane to identify studies assessing the effect of baseline TMTV and TLG on the survival of lymphoma patients. Pooled hazard ratios (HR) for overall survival (OS) and progression-free survival (PFS) were calculated, along with 95% confidence intervals (CI). Twenty-seven eligible studies including 2,729 patients were analysed. Patients with high baseline TMTV showed a worse prognosis with an HR of 3.05 (95% CI 2.55–3.64, p<0.00001) for PFS and an HR of 3.07 (95% CI 2.47–3.82, p<0.00001) for OS. Patients with high baseline TLG also showed a worse prognosis with an HR of 3.44 (95% CI 2.37–5.01, p<0.00001) for PFS and an HR of 3.08 (95% CI 1.84–5.16, p<0.00001) for OS. A high baseline TMTV was significantly associated with worse survival in DLBCL patients treated with R-CHOP (OS, pooled HR = 3.52; PFS, pooled HR = 2.93). A high baseline TLG was significantly associated with worse survival in DLBCL patients treated with R-CHOP (OS, pooled HR = 3.06; PFS, pooled HR = 2.93). The negative effect of high baseline TMTV on PFS was demonstrated in HL (pooled HR = 3.89). A high baseline TMTV was significantly associated with worse survival in ENKL patients (OS, pooled HR = 2.24; PFS, pooled HR = 3.25). A high baseline TLG was significantly associated with worse survival in ENKL patients (OS, pooled HR = 2.58; PFS, pooled HR = 2.99). High baseline TMTV or TLG predict significantly worse PFS and OS in patients with lymphoma. Future studies are warranted to explore whether TMTV or TLG could be integrated into various prognostic models for clinical decision making.
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Affiliation(s)
- Baoping Guo
- Department of Chemotherapy, Guangxi Cancer Hospital and of Guangxi Medical University Affiliated Cancer Hospital, Nanning, Guangxi, People’s Republic of China
| | - Xiaohong Tan
- Department of Chemotherapy, Guangxi Cancer Hospital and of Guangxi Medical University Affiliated Cancer Hospital, Nanning, Guangxi, People’s Republic of China
| | - Qing Ke
- Department of Chemotherapy, Guangxi Cancer Hospital and of Guangxi Medical University Affiliated Cancer Hospital, Nanning, Guangxi, People’s Republic of China
| | - Hong Cen
- Department of Chemotherapy, Guangxi Cancer Hospital and of Guangxi Medical University Affiliated Cancer Hospital, Nanning, Guangxi, People’s Republic of China
- * E-mail:
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Li C, Ma X, Pan Z, Lv F, Xia Z, Xue K, Zhang Q, Ji D, Cao J, Hong X, Guo Y. Role of radiotherapy in patients with limited diffuse large B-cell lymphoma of Waldeyer's ring in remission after R-CHOP immunochemotherapy. Leuk Res 2018; 74:80-85. [PMID: 30316031 DOI: 10.1016/j.leukres.2018.09.011] [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: 05/29/2018] [Revised: 09/18/2018] [Accepted: 09/22/2018] [Indexed: 11/27/2022]
Abstract
The standard treatment of waldeyer's ring DLBCL remains controversial. This retrospective study was designed to evaluate the role of consolidation radiotherapy (RT) in patients with stage I/II diffuse large B-cell lymphoma (DLBCL) limited in Waldeyer's ring (WR). We included 72 patients, 42 were treated with immunochemotherapy alone (CT group) and 30 were treated with immunochemotherapy followed by radiotherapy (CT + RT group). All patients received at least 3 cycles of R-CHOP regimen and achieved complete remission (CR) after immunochemotherapy. After 53 months median follow-up time, the 5-year progression-free survival (PFS) rates in CT + RT group vs. CT group were 93.3% vs. 92.5% (P = 0.896), the 5-year overall survival (OS) rates were 96.7% vs. 94.4% (P = 0.649). Patients with oropharyngeal primary had relatively better 5-year PFS and OS rates compared to nasopharyngeal primary (PFS: 98.2% vs. 73.3%, p = 0.001; OS: 100% vs. 79.0%, p < 0.001). Moreover, the primary site was the only independent prognostic factor for PFS in the multivariate analysis (p = 0.012, HR 16.858 [95% CI: 1.883-150.933]).
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Affiliation(s)
- Chunyan Li
- Department of Medical Oncology, Fudan University Shanghai Cancer Center, Shanghai, 200032, People's Republic of China; Shanghai Medical College, Fudan University, Shanghai, 200032, People's Republic of China.
| | - Xuejun Ma
- Shanghai Medical College, Fudan University, Shanghai, 200032, People's Republic of China; Department of Radiation Oncology, Fudan University Shanghai Cancer Center, Shanghai, 200032, People's Republic of China.
| | - Ziqiang Pan
- Shanghai Medical College, Fudan University, Shanghai, 200032, People's Republic of China; Department of Radiation Oncology, Fudan University Shanghai Cancer Center, Shanghai, 200032, People's Republic of China.
| | - Fangfang Lv
- Department of Medical Oncology, Fudan University Shanghai Cancer Center, Shanghai, 200032, People's Republic of China; Shanghai Medical College, Fudan University, Shanghai, 200032, People's Republic of China.
| | - Zuguang Xia
- Department of Medical Oncology, Fudan University Shanghai Cancer Center, Shanghai, 200032, People's Republic of China; Shanghai Medical College, Fudan University, Shanghai, 200032, People's Republic of China.
| | - Kai Xue
- Department of Medical Oncology, Fudan University Shanghai Cancer Center, Shanghai, 200032, People's Republic of China; Shanghai Medical College, Fudan University, Shanghai, 200032, People's Republic of China.
| | - Qunling Zhang
- Department of Medical Oncology, Fudan University Shanghai Cancer Center, Shanghai, 200032, People's Republic of China; Shanghai Medical College, Fudan University, Shanghai, 200032, People's Republic of China.
| | - Dongmei Ji
- Department of Medical Oncology, Fudan University Shanghai Cancer Center, Shanghai, 200032, People's Republic of China; Shanghai Medical College, Fudan University, Shanghai, 200032, People's Republic of China.
| | - Junning Cao
- Department of Medical Oncology, Fudan University Shanghai Cancer Center, Shanghai, 200032, People's Republic of China; Shanghai Medical College, Fudan University, Shanghai, 200032, People's Republic of China.
| | - Xiaonan Hong
- Department of Medical Oncology, Fudan University Shanghai Cancer Center, Shanghai, 200032, People's Republic of China; Shanghai Medical College, Fudan University, Shanghai, 200032, People's Republic of China.
| | - Ye Guo
- Department of Medical Oncology, Fudan University Shanghai Cancer Center, Shanghai, 200032, People's Republic of China; Shanghai Medical College, Fudan University, Shanghai, 200032, People's Republic of China; Department of Oncology, Tongji University East Hospital, Shanghai, People's Republic of China.
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Clinical characteristics and prognosis of primary Waldeyer's ring and lymph node diffuse large B-cell lymphoma in the rituximab era. Leuk Res 2017; 60:89-93. [DOI: 10.1016/j.leukres.2017.07.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2016] [Revised: 03/13/2017] [Accepted: 07/23/2017] [Indexed: 11/24/2022]
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Teh CS, Jayalakshmi P, Chong SY. Waldeyer ring lymphoma: a case series. EAR, NOSE & THROAT JOURNAL 2016; 93:E22-5. [PMID: 25255354 DOI: 10.1177/014556131409300905] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
We encountered a patient with a tongue base lymphoma that we initially diagnosed as a lingual tonsil in view of its benign appearance. We established the correct diagnosis of Waldeyer ring lymphoma by histology. This case led us to conduct a study of all cases of Waldeyer ring lymphoma that had been treated at our center during a 10-year period. We retrospectively examined our case records and found 35 such cases. From this group, we excluded 5 cases because of incomplete data. Thus our final study group was made up of 30 patients-14 males and 16 females, aged 14 to 76 years (mean: 51.6; median 54). The primary presenting signs and symptoms were dysphagia (n = 17 [57%]), a neck mass (n = 7 [23%]), nasal symptoms (n = 5 [17%]), and pain (n = 1 [3%]). Only 4 patients (13%) had B symptoms. A total of 20 patients (67%) presented with tonsillar involvement, 8 (27%) with nasopharyngeal involvement, 1 (3%) with tongue base lymphoma, and 1 with anterior tongue involvement. Most patients (77%) presented at an early stage. Histologically, 25 patients (83%) had high-grade diffuse large B-cell lymphoma, 4 (13%) had T-cell lymphoblastic lymphoma, and 1 (3%) had follicular lymphoma. Twenty-one patients (70%) were treated with chemotherapy, 4 (13%) received adjuvant chemotherapy with either radiotherapy or surgery, 3 (10%) resorted to other forms of treatment (primarily traditional remedies), and 2 (7%) declined treatment altogether. There were 14 patients (47%) alive at the end of the study period.
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Affiliation(s)
- Carren S Teh
- Department of Otorhinolaryngology, Sungai Buloh Hospital, Sungai Buloh, 47000 Selangor, Malaysia.
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Wang C, Li W, Liu C, He H, Bai O. Analysis of clinical and immunophenotypic features along with treatment outcomes of diffuse large B cell lymphoma patients, based on the involvement of nodal or extranodal primary sites. Blood Cells Mol Dis 2016; 57:42-9. [DOI: 10.1016/j.bcmd.2015.12.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2015] [Revised: 12/06/2015] [Accepted: 12/07/2015] [Indexed: 10/22/2022]
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Shi P, Meng X, Ni M, Sun X, Xing L, Yu J. Association between serum tumor markers and metabolic tumor volume or total lesion glycolysis in patients with recurrent small cell lung cancer. Oncol Lett 2015; 10:3123-3128. [PMID: 26722299 DOI: 10.3892/ol.2015.3673] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2014] [Accepted: 07/16/2015] [Indexed: 11/06/2022] Open
Abstract
The aim of the present study was to investigate the association between serum tumor markers and the metabolic tumor volume (MTV) or total lesion glycolysis (TLG), as determined by fluorine-18 fluorodeoxyglucose (18F-FDG) positron emission tomography-computed tomography (PET/CT) in patients with recurrent small cell lung cancer (SCLC). Data from 21 patients with recurrent SCLC were collected. The levels of neuron-specific enolase (NSE), carcinoembryonic antigen (CEA) and cytokeratin 19 fragment 21-1 were measured at the time of the 18F-FDG PET/CT examination. The MTV and TLG of all lesions were calculated. Pearson correlation analyses were used to estimate the correlations between NSE level and PET findings. Pearson correlation analyses showed that NSE was the only tumor marker to have a strong correlation with MTV or TLG (r=0.787, P<0.001; r=0.866, P<0.001, respectively). In patients with a normal NSE level, no correlation was found between NSE and MTV or TLG (r=0.018, P=0.958; r=-0.003, P=0.92, respectively), but a significant correlation was found in patients with an abnormal NSE level (r=0.789, P<0.01; r=0.872, P=0.01, respectively). Therefore, TLG and MTV may serve as sensitive markers of tumor burden in patients with recurrent SCLC, with TLG showing greater sensitivity. In patients with an abnormal NSE level, a higher NSE level indicates greater MTV and TLG.
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Affiliation(s)
- Pengyue Shi
- Department of Radiation Oncology, Shandong Cancer Hospital, Shandong University, Jinan, Shandong 250117, P.R. China
| | - Xue Meng
- Department of Radiation Oncology, Shandong Cancer Hospital, Shandong University, Jinan, Shandong 250117, P.R. China
| | - Mengmeng Ni
- Department of Radiation Oncology, Shandong Cancer Hospital, Shandong University, Jinan, Shandong 250117, P.R. China
| | - Xindong Sun
- Department of Radiation Oncology, Shandong Cancer Hospital, Shandong University, Jinan, Shandong 250117, P.R. China
| | - Ligang Xing
- Department of Radiation Oncology, Shandong Cancer Hospital, Shandong University, Jinan, Shandong 250117, P.R. China
| | - Jinming Yu
- Department of Radiation Oncology, Shandong Cancer Hospital, Shandong University, Jinan, Shandong 250117, P.R. China
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Thakral B, Zhou J, Medeiros LJ. Extranodal hematopoietic neoplasms and mimics in the head and neck: an update. Hum Pathol 2015; 46:1079-100. [PMID: 26118762 DOI: 10.1016/j.humpath.2015.05.007] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2015] [Revised: 05/03/2015] [Accepted: 05/08/2015] [Indexed: 12/30/2022]
Abstract
The head and neck region is a common site for extranodal lymphomas, second only to the gastrointestinal tract; and 12% to 15% of all head and neck tumors are lymphomas. Non-Hodgkin lymphomas are most common, and Hodgkin lymphoma occurs rarely at extranodal sites in the head and neck. Most non-Hodgkin lymphomas of the head and neck region are of B-cell lineage, and the Waldeyer ring is the most common site. Head and neck lymphomas have distinctive epidemiological and clinicopathologic features, including an association with immunosuppression, infectious organisms, or autoimmune disorders; site-specific differences (eg, thyroid gland versus ocular adnexa) for common lymphomas, such as extranodal marginal zone B-cell lymphoma of mucosa-associated lymphoid tissue; and genetic differences that provide insights into etiology. Furthermore, the diagnosis of non-Hodgkin lymphomas at extranodal sites implies differences in prognosis and therapeutic implications with lymphomas at nodal sites. In this review, we discuss various types of non-Hodgkin lymphomas and Hodgkin lymphoma, focusing on unique aspects related to the head and neck region. We also discuss a number of newer entities that are clinically indolent as well as mimics of lymphoma that can occur in the head and neck region, including infectious mononucleosis, Kikuchi-Fujimoto disease, Kimura disease, Castleman disease, and immunoglobulin G4-related disease.
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Affiliation(s)
- Beenu Thakral
- Department of Hematopathology, The University of Texas M.D. Anderson Cancer Center, Houston, TX 77030, USA.
| | - Jane Zhou
- Tufts Medical Center/Tufts University Medical School, 800 Washington Street, Box 802, Boston, MA 02111
| | - L Jeffrey Medeiros
- Department of Hematopathology, The University of Texas M.D. Anderson Cancer Center, Houston, TX 77030, USA
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Song MK, Chung JS, Lee JJ, Jeong SY, Lee SM, Hong JS, Chong A, Moon JH, Kim JH, Lee SM, Kim SJ, Shin HJ. Metabolic tumor volume by positron emission tomography/computed tomography as a clinical parameter to determine therapeutic modality for early stage Hodgkin's lymphoma. Cancer Sci 2013; 104:1656-61. [PMID: 24033666 DOI: 10.1111/cas.12282] [Citation(s) in RCA: 76] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2013] [Revised: 08/27/2013] [Accepted: 08/28/2013] [Indexed: 01/22/2023] Open
Abstract
Recent studies have shown that metabolic tumor volume (MTV) by positron emission tomography/computed tomography (PET/CT) is an important prognostic parameter in patients with non-Hodgkin's lymphoma. However, it is unknown whether doxorubicin, bleomycin, vinblastine, dacarbazine (ABVD) alone in early stage Hodgkin's lymphoma would lead to similar disease control as combined modality therapy (CMT) using MTV by PET/CT. One hundred and twenty-seven patients with early stage Hodgkin's lymphoma who underwent PET/CT at diagnosis were enrolled. The MTV was delineated on PET/CT by the area ≥SUV(max), 2.5 (standardized uptake value [SUV]). Sixty-six patients received six cycles of ABVD only. The other 61 patients received CMT (involved-field radiotherapy after 4-6 cycles of ABVD). The calculated MTV cut-off value was 198 cm(3) . Clinical outcomes were compared according to several prognostic factors (i.e. age ≥50 years, male, performance status ≥2, stage II, B symptoms, ≥4 involved sites, extranodal site, large mediastinal mass, CMT, elevated erythrocyte sedimentation rate and high MTV). Older age (progression-free survival [PFS], P = 0.003; overall survival [OS], P = 0.007), B symptoms (PFS, P = 0.006; OS, P = 0.036) and high MTV (PFS, P = 0.008; OS, P = 0.007) were significant independent prognostic factors. Survival of two high MTV groups treated with ABVD only and CMT were lower than the low MTV groups (PFS, P < 0.012; OS, P < 0.045). ABVD alone was sufficient to control disease in those with low MTV status. However, survival was poor, even if the CMT was assigned a high MTV status. The MTV would be helpful for deciding the therapeutic modality in patients with early stage Hodgkin's lymphoma.
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Affiliation(s)
- Moo-Kon Song
- Department of Hematology-Oncology, Pusan National University Hospital Medical Research Institute, Busan, Korea
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