1
|
Wang R, Zhang Y, Fan Q, Jiang M, Zou L, Su M. Appropriate timing to perform an interim 18F-FDG PET/CT in patients with nasal-type extranodal natural killer/T cell lymphoma. Ann Hematol 2024; 103:885-892. [PMID: 38030892 DOI: 10.1007/s00277-023-05562-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2023] [Accepted: 11/21/2023] [Indexed: 12/01/2023]
Abstract
Interim 18F-FDG PET/CT (I-PET) has a role in response evaluation and treatment guidance in patients with nasal-type extranodal natural killer/T cell lymphoma (ENKTL). However, there was no agreement on the timing of I-PET performed, after chemotherapy or after chemoradiotherapy. We aimed to find the appropriate timing for I-PET by assessing the prognostic value of I-PET in response evaluation in ENKTL patients. Two hundred and twenty-seven ENKTL patients who had undergone I-PET were retrospectively included. All patients were grouped based on their therapeutic strategy received, chemotherapy or chemoradiotherapy. The Deauville 5-point score (DS) was used to interpret the I-PET images. The hazard ratio (HR) and C-index were used to measure the discriminatory and prognostic capacities of I-PET performed at different times. One hundred and six patients underwent the I-PET after chemotherapy (chemotherapy group), while I-PET was performed after chemoradiotherapy in 121 patients (chemoradiotherapy group). Eighty-seven patients were classified as metabolic remission (DS score of 1-3), while the other 140 were classified as non-metabolic remission (DS score of 4-5) according to the Deauville criteria. There were no significant survival differences between patients in metabolic remission and in non-metabolic remission in either progression-free survival (PFS, p = 0.406) or overall survival (OS, p = 0.350). In the chemotherapy group, patients in metabolic remission had significantly superior PFS than patients in non-metabolic remission (p = 0.012). For OS, a discriminative trend was also found on the survival curve between patients in metabolic remission and in non-metabolic remission (p = 0.082). In the chemoradiotherapy group, there was no significant difference in PFS (P = 0.185) or OS (P = 0.627) between patients in metabolic remission and in non-metabolic remission. I-PET after chemotherapy yields higher discriminative power and has the ability for prognostic prediction in nasal-type ENKTL patients. I-PET after radiochemotherapy has no prognostic value. Thus, the appropriate timing for I-PET is after chemotherapy but before radiotherapy for response evaluation in nasal-type ENKTL patients.
Collapse
Affiliation(s)
- Rang Wang
- Department of Nuclear Medicine, West China Hospital, Sichuan University, 37 Guoxue Alley, Chengdu, 610041, Sichuan, China
| | - Yue Zhang
- Department of Nuclear Medicine, West China Hospital, Sichuan University, 37 Guoxue Alley, Chengdu, 610041, Sichuan, China
| | - Qiuping Fan
- Department of Nuclear Medicine, West China Hospital, Sichuan University, 37 Guoxue Alley, Chengdu, 610041, Sichuan, China
| | - Ming Jiang
- Department of Medical Oncology, Cancer Center, West China Hospital, Sichuan University, 37 Guoxue Alley, Chengdu, 610041, Sichuan, China
| | - Liqun Zou
- Department of Medical Oncology, Cancer Center, West China Hospital, Sichuan University, 37 Guoxue Alley, Chengdu, 610041, Sichuan, China
| | - Minggang Su
- Department of Nuclear Medicine, West China Hospital, Sichuan University, 37 Guoxue Alley, Chengdu, 610041, Sichuan, China.
| |
Collapse
|
2
|
Nakamura T, Tatetsu H, Higuchi Y, Endo S, Shiraishi S, Kawanaka K, Imakane D, Sonoda M, Furuta R, Shichijo T, Honda Y, Karube K, Mikami Y, Nosaka K, Matsuoka M, Yasunaga JI. Extranodal NK/T-cell lymphoma with localized relapse in bone marrow of lower leg detected using PET-CT. J Clin Exp Hematop 2024; 64:45-51. [PMID: 38538318 PMCID: PMC11079990 DOI: 10.3960/jslrt.23046] [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: 10/09/2023] [Revised: 11/27/2023] [Accepted: 12/27/2023] [Indexed: 05/12/2024] Open
Abstract
Extranodal natural killer (NK)/T-cell lymphoma (ENKTL) is a rare subtype of non-Hodgkin lymphoma (NHL) with poor prognosis, particularly in relapsed or refractory patients. Thus, timely detection of relapse and appropriate disease management are crucial. We present two patients with ENKTL, wherein positron emission tomography-computed tomography (PET-CT) with total-body coverage after induction therapy, detected newly relapsed regions in the bone marrow of the lower leg prior to progression. Case 1: A 47-year-old woman with nasal obstruction, showing 18F-fluoro-deoxyglucose (FDG) uptake in the nasal cavity (Lugano stage IE). After induction therapy (RT-2/3 DeVIC), PET-CT revealed abnormal uptake only in the right fibula. Case 2: A 68-year-old man with a skin nodule/ulcer and an enlarged right inguinal lymph node was diagnosed with advanced ENKTL. A PET-CT scan revealed abnormal uptake in the subcutaneous mass of the right medial thigh, lymph nodes, and descending colon (Lugano stage IV). After induction therapy, PET-CT revealed new abnormal uptake only in the left tibia. In both patients, CT-guided biopsy confirmed ENKTL recurrence. Moreover, PET-CT with whole-body coverage was useful for the timely assessment of relapse and detection of asymptomatic bone involvement. This approach allowed for modifications to treatment strategies in certain patients.
Collapse
|
3
|
Murthy V, Gafita A, Thin P, Nguyen K, Grogan T, Shen J, Drakaki A, Rettig M, Czernin J, Calais J. Prognostic Value of End-of-Treatment PSMA PET/CT in Patients Treated with 177Lu-PSMA Radioligand Therapy: A Retrospective, Single-Center Analysis. J Nucl Med 2023; 64:1737-1743. [PMID: 37678927 DOI: 10.2967/jnumed.122.265155] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2022] [Revised: 06/21/2023] [Indexed: 09/09/2023] Open
Abstract
Our objective was to evaluate the prognostic value of end-of-treatment prostate-specific membrane antigen (PSMA) PET/CT (PSMA-PET) in patients with metastatic castration-resistant prostate cancer (mCRPC) treated with 177Lu-PSMA radioligand therapy (PSMA-RLT). Methods: This was a single-center retrospective study. mCRPC patients who underwent PSMA-RLT with available baseline PSMA-PET (bPET) and end-of-treatment PSMA-PET (ePET) within 6 mo of the last PSMA-RLT cycle were eligible. Overall survival (OS) and prostate-specific antigen (PSA) progression status at the time of ePET (by Prostate Cancer Clinical Trials Working Group 3 criteria) were collected. PSMA-PET tumor segmentation was performed to obtain whole-body PSMA tumor volume (PSMA-VOL) and define progressive (≥20% increase) versus nonprogressive disease. Pairs of bPET and ePET were interpreted for appearance of new lesions. Response Evaluation Criteria in PSMA-PET/CT (RECIP) 1.0 were also applied to define progressive versus nonprogressive disease. The associations between changes in PSMA-VOL, new lesions, RECIP 1.0, and PSA progression status at the time of ePET with OS were evaluated by Kaplan-Meier analysis. Results: Twenty mCRPC patients were included. The median number of treatment cycles was 3.5 (interquartile range [IQR], 2-4). The median time between bPET and cycle 1 of PSMA-RLT was 1.0 mo (IQR, 0.7-1.8 mo). The median time between the last cycle of PSMA-RLT and ePET was 1.9 mo (IQR, 1.2-3.5 mo). Twelve of 20 patients (60%) had died at the last follow-up. The median follow-up time from ePET for survivors was 31.2 mo (IQR, 6.8-40.7 mo). The median OS from ePET was 11.4 mo (IQR, 6.8-30.7 mo). Patients with new lesions on ePET had shorter OS than those without new lesions (median OS, 10.7 mo [95% CI, 9.2-12.2] vs. not reached; P = 0.002). Patients with progressive PSMA-VOL had shorter OS than those with nonprogressive PSMA-VOL (median OS, 10.7 mo [95% CI: 9.7-11.7 mo] vs. not reached; P = 0.007). Patients with progressive RECIP had shorter OS than those with nonprogressive RECIP (median OS, 10.7 mo [95% CI, 9.7-11.7 mo] vs. not reached; P = 0.007). PSA progression at the time of ePET was associated with shorter OS (median, 10.9 mo [95% CI, 9.4-12.4 mo] vs. not reached; P = 0.028). Conclusion: In this retrospective study of 20 mCRPC patients treated with PSMA-RLT, progression on ePET by the appearance of new lesions, changes in PSMA-VOL, and RECIP 1.0 was prognostic for OS. Validation in larger, prospective multicentric clinical trials is warranted.
Collapse
Affiliation(s)
- Vishnu Murthy
- Ahmanson Translational Theranostics Division, Department of Molecular and Medical Pharmacology, David Geffen School of Medicine at UCLA, Los Angeles, California
| | - Andrei Gafita
- Ahmanson Translational Theranostics Division, Department of Molecular and Medical Pharmacology, David Geffen School of Medicine at UCLA, Los Angeles, California;
| | - Pan Thin
- Ahmanson Translational Theranostics Division, Department of Molecular and Medical Pharmacology, David Geffen School of Medicine at UCLA, Los Angeles, California
| | - Kathleen Nguyen
- Ahmanson Translational Theranostics Division, Department of Molecular and Medical Pharmacology, David Geffen School of Medicine at UCLA, Los Angeles, California
| | - Tristan Grogan
- Department of Medicine Statistics Core, David Geffen School of Medicine at UCLA, Los Angeles, California; and
| | - John Shen
- Division of Hematology/Oncology, Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, California
| | - Alexandra Drakaki
- Division of Hematology/Oncology, Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, California
| | - Matthew Rettig
- Division of Hematology/Oncology, Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, California
| | - Johannes Czernin
- Ahmanson Translational Theranostics Division, Department of Molecular and Medical Pharmacology, David Geffen School of Medicine at UCLA, Los Angeles, California
| | - Jeremie Calais
- Ahmanson Translational Theranostics Division, Department of Molecular and Medical Pharmacology, David Geffen School of Medicine at UCLA, Los Angeles, California
| |
Collapse
|
4
|
Chen X, Zhao S, Wang H, Fu C, Tian R, Zou L. Assessment of the prognostic value of interim fluorodeoxyglucose positron emission tomography/computed tomography in nasal-type extranodal natural killer/T-cell lymphoma. Quant Imaging Med Surg 2021; 11:1220-1233. [PMID: 33816162 DOI: 10.21037/qims-20-620] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Background The prognostic value of interim positron emission tomography/computed tomography (PET/CT) for nasal-type extranodal natural killer/T-cell lymphoma (ENKTL) is controversial. We evaluated the prognostic value of interim PET/CT in ENKTL patients to facilitate risk stratification and guide clinical treatment. Methods Patients with ENKTL who received first-line chemotherapy based on L-asparaginase/pegaspargase with/without involved-field radiotherapy were recruited for this study. Pretreatment and interim PET/CT evaluations were performed. Interim PET/CT was evaluated via the maximum standardized uptake value (SUVmax) and the Deauville 5-point scale (DS); and the capacity to predict progression-free survival (PFS) and overall survival (OS) was evaluated. Receiver operating characteristic (ROC) curves were used to determine the optimal SUVmax cutoff. Fisher's exact test was used to analyze relationships between interim PET/CT results and clinical characteristics. Univariate and multivariate analyses were performed to examine the independent effects of interim PET/CT. The Cochran-Mantel-Haenszel test was used to assess the prognostic value of interim PET/CT at different timepoints. Results Overall, 129 ENKTL patients were enrolled. The optimal interim PET/CT SUVmax cut-off was 4.95. The median follow-up was 34 [2-90] months, in the low SUVmax group (≤4.95), the 2-year PFS and OS rates were 76.3% and 88.0%, respectively; in the high SUVmax group (>4.95), the PFS and OS rates were 15.6% and 44.5%, respectively. Likewise, for the DS 1-3 group, the PFS and OS rates were 78.9% and 91.2%, respectively; and in the DS 4 or 5 group, the rates of PFS and OS were 49.7% and 69.0%, respectively. In univariate analysis, interim PET/CT evaluation based on SUVmax and DS scores were both PFS and OS predictors. In multivariate analysis, SUVmax was independently significantly associated with PFS (P<0.001) and OS (P=0.002), and DS was independently significantly associated with PFS (P=0.004) but not OS (P=0.204). In the Cochran-Mantel-Haenszel testing, the SUVmax and DS were significantly associated with PFS and OS after adjustments for the interim PET/CT timing. Conclusions Interim PET/CT was of prognostic value concerning ENKTL. The SUVmax is an independent prognostic indicator of PFS and OS, while the DS is an independent prognostic indicator of PFS but not OS. The SUVmax is of greater prognostic value than DS.
Collapse
Affiliation(s)
- Xi Chen
- Department of Medical Oncology, Cancer Center, West China Hospital of Sichuan University, Chengdu, China
| | - Shengnan Zhao
- Department of Medical Oncology, Cancer Center, West China Hospital of Sichuan University, Chengdu, China
| | - Hongxi Wang
- Department of Nuclear Medicine, West China Hospital of Sichuan University, Chengdu, China
| | - Chunxi Fu
- Department of Medical Oncology, Cancer Center, West China Hospital of Sichuan University, Chengdu, China
| | - Rong Tian
- Department of Nuclear Medicine, West China Hospital of Sichuan University, Chengdu, China
| | - Liqun Zou
- Department of Medical Oncology, Cancer Center, West China Hospital of Sichuan University, Chengdu, China
| |
Collapse
|
5
|
Dynamic evaluation of the prognostic value of 18F-FDG PET/CT in extranodal NK/T-cell lymphoma, nasal type. Ann Hematol 2021; 100:1039-1047. [PMID: 33634350 DOI: 10.1007/s00277-021-04466-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2020] [Accepted: 02/18/2021] [Indexed: 10/22/2022]
Abstract
Extranodal natural killer/T-cell lymphoma, nasal-type (ENKTL) is a type of rare and distinct entity of non-Hodgkin lymphoma with poor prognosis. It is important to evaluate the early treatment response accurately to decide further treatment strategy. 18F-FDG PET/CT plays an important role in response evaluation and prognostic prediction in some kinds of lymphomas. However, data available regarding patients with ENKTL are limited. Thus, in this prospective study, we analyzed the prognostic value of 18F-FDG PET/CT in ENKTL. Thirty-four patients with newly diagnosed ENKTL were enrolled in this phase 2 study (NCT02825147, July 7, 2016). The patients received pre-, mid-, and end-treatment 18F-FDG PET/CT scans. Deauville score (DS), maximal standardized uptake values (SUVmax), and the change in SUVmax (ΔSUVmax) were recorded for response assessment. The median follow-up period was 42.2 months. The 2-year overall survival (OS) and progression-free survival (PFS) were 82.4% and 73.5%, respectively. Univariate analysis revealed that Ann Arbor stage (P < 0.002), mid-treatment DS (P = 0.005), mid-SUVmax (P = 0.001), mid-∆SUVmax (P = 0.004), end-treatment DS (P < 0.001), and end-SUVmax (P = 0.014) were prognostic factors for OS. Ann Arbor stage (P = 0.001), mid-treatment DS (P = 0.008), mid-SUVmax (P = 0.029), mid-∆SUVmax (P < 0.001), and end-treatment DS (P =0.021) were of prognostic significance for PFS. Multivariate analysis showed that mid-SUVmax (P = 0.042) and DS at the middle (P = 0.050) and end (P = 0.044) of treatment were significant independent predictors of PFS. 18F-FDG PET/CT is useful for predicting the prognosis of ENKTL.
Collapse
|
6
|
Weakly supervised deep learning for determining the prognostic value of 18F-FDG PET/CT in extranodal natural killer/T cell lymphoma, nasal type. Eur J Nucl Med Mol Imaging 2021; 48:3151-3161. [PMID: 33611614 PMCID: PMC7896833 DOI: 10.1007/s00259-021-05232-3] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2020] [Accepted: 02/01/2021] [Indexed: 12/22/2022]
Abstract
Purpose To develop a weakly supervised deep learning (WSDL) method that could utilize incomplete/missing survival data to predict the prognosis of extranodal natural killer/T cell lymphoma, nasal type (ENKTL) based on pretreatment 18F-FDG PET/CT results. Methods One hundred and sixty-seven patients with ENKTL who underwent pretreatment 18F-FDG PET/CT were retrospectively collected. Eighty-four patients were followed up for at least 2 years (training set = 64, test set = 20). A WSDL method was developed to enable the integration of the remaining 83 patients with incomplete/missing follow-up information in the training set. To test generalization, these data were derived from three types of scanners. Prediction similarity index (PSI) was derived from deep learning features of images. Its discriminative ability was calculated and compared with that of a conventional deep learning (CDL) method. Univariate and multivariate analyses helped explore the significance of PSI and clinical features. Results PSI achieved area under the curve scores of 0.9858 and 0.9946 (training set) and 0.8750 and 0.7344 (test set) in the prediction of progression-free survival (PFS) with the WSDL and CDL methods, respectively. PSI threshold of 1.0 could significantly differentiate the prognosis. In the test set, WSDL and CDL achieved prediction sensitivity, specificity, and accuracy of 87.50% and 62.50%, 83.33% and 83.33%, and 85.00% and 75.00%, respectively. Multivariate analysis confirmed PSI to be an independent significant predictor of PFS in both the methods. Conclusion The WSDL-based framework was more effective for extracting 18F-FDG PET/CT features and predicting the prognosis of ENKTL than the CDL method. Supplementary Information The online version contains supplementary material available at 10.1007/s00259-021-05232-3.
Collapse
|
7
|
Gerke O, Ehlers K, Motschall E, Høilund-Carlsen PF, Vach W. PET/CT-Based Response Evaluation in Cancer-a Systematic Review of Design Issues. Mol Imaging Biol 2021; 22:33-46. [PMID: 31016638 DOI: 10.1007/s11307-019-01351-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Positron emission tomography/x-ray computed tomography (PET/CT) has long been discussed as a promising modality for response evaluation in cancer. When designing respective clinical trials, several design issues have to be addressed, especially the number/timing of PET/CT scans, the approach for quantifying metabolic activity, and the final translation of measurements into a rule. It is unclear how well these issues have been tackled in quest of an optimised use of PET/CT in response evaluation. Medline via Ovid and Science Citation Index via Web of Science were systematically searched for articles from 2015 on cancer patients scanned with PET/CT before and during/after treatment. Reports were categorised as being either developmental or evaluative, i.e. focusing on either the establishment or the evaluation of a rule discriminating responders from non-responders. Of 124 included papers, 112 (90 %) were accuracy and/or prognostic studies; the remainder were response-curve studies. No randomised controlled trials were found. Most studies were prospective (62 %) and from single centres (85 %); median number of patients was 38.5 (range 5-354). Most (69 %) of the studies employed only one post-baseline scan. Quantification was mainly based on SUVmax (91 %), while change over time was most frequently used to combine measurements into a rule (79 %). Half of the reports were categorised as developmental, the other half evaluative. Most development studies assessed only one element (35/62, 56 %), most frequently the choice of cut-off points (25/62, 40 %). In summary, the majority of studies did not address the essential open issues in establishing PET/CT for response evaluation. Reasonably sized multicentre studies are needed to systematically compare the many different options when using PET/CT for response evaluation.
Collapse
Affiliation(s)
- Oke Gerke
- Department of Nuclear Medicine, Odense University Hospital, Odense, Denmark. .,Department of Clinical Research, University of Southern Denmark, Odense, Denmark.
| | - Karen Ehlers
- Department of Nuclear Medicine, Odense University Hospital, Odense, Denmark.,Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Edith Motschall
- Institute of Medical Biometry and Statistics, Faculty of Medicine and Medical Center, University of Freiburg, Freiburg, Germany
| | - Poul Flemming Høilund-Carlsen
- Department of Nuclear Medicine, Odense University Hospital, Odense, Denmark.,Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Werner Vach
- Department of Orthopaedics and Traumatology, University Hospital Basel, Basel, Switzerland
| |
Collapse
|
8
|
Li H, Shao G, Zhang Y, Chen X, Du C, Wang K, Gao Z. Nomograms based on SUVmax of 18F-FDG PET/CT and clinical parameters for predicting progression-free and overall survival in patients with newly diagnosed extranodal natural killer/T-cell lymphoma. Cancer Imaging 2021; 21:9. [PMID: 33419476 PMCID: PMC7796613 DOI: 10.1186/s40644-020-00379-y] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Accepted: 12/29/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The prognostic value of 18F-FDG PET/CT in extranodal natural killer/T-cell lymphoma (ENKTL) is not well established. We aimed to develop nomograms for individualized estimates of progression-free survival (PFS) and overall survival (OS) in patients with ENKTL using 18F-FDG PET/CT parameters and clinical parameters. METHODS A total of 171 patients with newly diagnosed ENKTL undergoing 18F-FDG PET/CT scanning were retrospectively analyzed. Nomograms were constructed according to multivariate Cox proportional hazards regression. The predictive and discriminatory capacities of the nomograms were then measured using the concordance index (C-index), calibration plots, and Kaplan-Meier curves. The C-index, the area under receiver operating characteristic (ROC) curve (AUC), and decision curve analysis (DCA) were used to contrast the predictive and discriminatory capacities of the nomograms against with the International Prognostic Index (IPI) and Korean Prognostic Index (KPI). RESULTS Multivariate analysis demonstrated that pretreatment SUVmax≥9.5, disease stage II and III-IV, elevated lactate dehydrogenase (LDH), and elevated β2-microglobulin (β2-MG) had the strongest association with unfavorable PFS and OS. In addition, hemoglobin (Hb) < 120 g/L had a tendency to be associated with PFS. Both nomogram models incorporated SUVmax, Ann Arbor stage, LDH, and β2-MG. The PFS nomogram also included Hb. The nomograms showed good prediction accuracies, with the C-indexes for PFS and OS were 0.729 and 0.736, respectively. The calibration plots for 3-year and 5-year PFS/OS reported good consistency between predicted and observed probabilities for survival time. The PFS and OS were significantly different according to tertiles of nomogram scores (p < 0.001). The C-index and AUCs of the nomograms were higher than that of IPI and KPI. Moreover, DCA showed that the predictive accuracy of the nomograms for PFS and OS were both higher than that of IPI and KPI. CONCLUSIONS This study established nomograms that incorporate pretreatment SUVmax and clinical parameters, which could be effective tools for individualized prognostication of both PFS and OS in patients with newly diagnosed ENKTL.
Collapse
Affiliation(s)
- Hongyan Li
- Department of Nuclear Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, No. 1277 Jiefang Ave, Wuhan, 430022, China.,Hubei Province Key Laboratory of Molecular Imaging, Wuhan, 430022, China
| | - Guozhu Shao
- Hubei Province Key Laboratory of Molecular Imaging, Wuhan, 430022, China.,Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, No. 1277 Jiefang Ave, Wuhan, 430022, China
| | - Yajing Zhang
- Department of Nuclear Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, No. 1277 Jiefang Ave, Wuhan, 430022, China.,Hubei Province Key Laboratory of Molecular Imaging, Wuhan, 430022, China
| | - Xiaomin Chen
- Department of Nuclear Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, No. 1277 Jiefang Ave, Wuhan, 430022, China.,Hubei Province Key Laboratory of Molecular Imaging, Wuhan, 430022, China
| | - Chengcheng Du
- Department of Nuclear Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, No. 1277 Jiefang Ave, Wuhan, 430022, China.,Hubei Province Key Laboratory of Molecular Imaging, Wuhan, 430022, China
| | - Kun Wang
- Department of Nuclear Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, No. 1277 Jiefang Ave, Wuhan, 430022, China.,Hubei Province Key Laboratory of Molecular Imaging, Wuhan, 430022, China
| | - Zairong Gao
- Department of Nuclear Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, No. 1277 Jiefang Ave, Wuhan, 430022, China. .,Hubei Province Key Laboratory of Molecular Imaging, Wuhan, 430022, China.
| |
Collapse
|
9
|
Xia X, Wang Y, Yuan J, Sun W, Jiang J, Liu C, Zhang Q, Ma X. Baseline SUVmax of 18F-FDG PET-CT indicates prognosis of extranodal natural killer/T-cell lymphoma. Medicine (Baltimore) 2020; 99:e22143. [PMID: 32925768 PMCID: PMC7489640 DOI: 10.1097/md.0000000000022143] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Abstract
To evaluate the prognostic value of the baseline SUVmax of F-FDG PET-CT in extranodal natural killer/T-cell lymphoma (NKTCL) patients.From January 2010 to December 2015, 141 extranodal NKTCL patients with staging F-FDG PET-CT scan were divided into two group based on SUVmax cutoff value obtained from operating characteristic (ROC) curves. All the patients received radiotherapy, chemotherapy or chemoradiation. Survival analysis was performed on the basis of SUVmax.The median baseline SUVmax of the tumors was 11.67 (range 2.6-34.6). The ROC curves showed that the optimal cutoff of the baseline SUVmax was 9.65. The patients were divided into two groups: low SUV group (SUVmax < 9.65) and high SUV group (SUVmax ≥ 9.65). Patients in high SUV group were more likely to have invasive disease outside the nasal cavity (P < .001), poorer ECOG scores (P = .012) and higher LDH levels (P = .034). The univariate survival analyses indicated that high SUVmax was a poor prognostic factor for overall survival (OS, P = .038), progression free survival (PFS, P = .006) and distant relapse free survival (DRFS, P = .001), but not for local recurrence free survival (LRFS, P > .05). These results were consistent with that of the survival analyses using the Kaplan-Meier method. The multivariate survival analyses showed that the baseline SUVmax was no longer a prognostic factor for OS (HR 1.99, 95% CI 0.81-4.88, P = .135), but it still indicated worse PFS (HR 2.6, 95% CI 1.24-5.46, P = .012) and DRFS (HR 4.58, 95% CI 1.83-11.46, P = .001) independent of other variables.For extranodal NKTCL patients, a higher baseline SUVmax of F-FDG PET-CT was associated with more aggressive clinical features. An SUVmax ≥ 9.65 was an independent poor prognostic factor for DRFS and PFS. Thus, the baseline SUVmax may be a valuable tool to help identify patients with a high risk of disease progression.
Collapse
Affiliation(s)
- Xianwu Xia
- Department of Radiology, Municipal Hospital Affiliated to Medical School of Taizhou University, Taizhou, Zhejiang
- Department of Radiation Oncology, Fudan University Shanghai Cancer Center
| | - Yaqi Wang
- Department of Radiation Oncology, Fudan University Shanghai Cancer Center
- Department of Oncology, Shanghai Medical College, Fudan University
| | - Jianjun Yuan
- Department of Radiology, Municipal Hospital Affiliated to Medical School of Taizhou University, Taizhou, Zhejiang
| | - Wenjie Sun
- Department of Radiation Oncology, Fudan University Shanghai Cancer Center
- Department of Oncology, Shanghai Medical College, Fudan University
| | - Jinjin Jiang
- Department of Oncology, Shanghai Medical College, Fudan University
- Department of Nuclear Medicine, Fudan University Shanghai Cancer Center
| | - Chang Liu
- Department of Oncology, Shanghai Medical College, Fudan University
- Department of Nuclear Medicine, Fudan University Shanghai Cancer Center
| | - Qunling Zhang
- Department of Oncology, Shanghai Medical College, Fudan University
- Department of Medical Oncology, Fudan University Shanghai Cancer Center, Shanghai, PR China
| | - Xuejun Ma
- Department of Radiation Oncology, Fudan University Shanghai Cancer Center
- Department of Oncology, Shanghai Medical College, Fudan University
| |
Collapse
|
10
|
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]
|
11
|
Qian L, Yan M, Zhang W, Zhou D, Zhang Y, Huo L, Luo Y, Zhang Y, Hu S. Prognostic value of interim 18F-FDG PET/CT in T-cell lymphomas. Leuk Lymphoma 2019; 61:927-933. [PMID: 31795794 DOI: 10.1080/10428194.2019.1697815] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Affiliation(s)
- Long Qian
- Department of Hematology, Peking Union Medical College Hospital, Beijing, China
| | - Miaoming Yan
- Department of Hematology, Peking Union Medical College Hospital, Beijing, China
| | - Wei Zhang
- Department of Hematology, Peking Union Medical College Hospital, Beijing, China
| | - Daobin Zhou
- Department of Hematology, Peking Union Medical College Hospital, Beijing, China
| | - Yan Zhang
- Department of Hematology, Peking Union Medical College Hospital, Beijing, China
| | - Li Huo
- Department of Nuclear Medicine, Peking Union Medical College Hospital, Beijing, China
| | - Yaping Luo
- Department of Nuclear Medicine, Peking Union Medical College Hospital, Beijing, China
| | - Yingqiang Zhang
- Department of Nuclear Medicine, Peking Union Medical College Hospital, Beijing, China
| | - Shaoxuan Hu
- Department of Hematology, Peking Union Medical College Hospital, Beijing, China
| |
Collapse
|
12
|
Peacock JG, Christensen CT, Banks KP. RESISTing the Need to Quantify: Putting Qualitative FDG-PET/CT Tumor Response Assessment Criteria into Daily Practice. AJNR Am J Neuroradiol 2019; 40:1978-1986. [PMID: 31780460 DOI: 10.3174/ajnr.a6294] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2019] [Accepted: 09/11/2019] [Indexed: 12/20/2022]
Abstract
Tumor response assessments are essential to evaluate cancer treatment efficacy and prognosticate survival in patients with cancer. Response criteria have evolved over multiple decades, including many imaging modalities and measurement schema. Advances in FDG-PET/CT have led to tumor response criteria that harness the power of metabolic imaging. Qualitative PET/CT assessment schema are easy to apply clinically, are reproducible, and yield good prognostic results. We present 3 such criteria, namely, the Lugano classification for lymphoma, the Hopkins criteria, and the Neck Imaging Reporting and Data Systems criteria for head and neck cancers. When comparing baseline PET/CTs with interim or end-of-treatment PET/CTs, radiologists can classify the tumor response as complete metabolic response, partial metabolic response, no metabolic response, or progressive disease, which has important implications in directing further cancer management and long-term patient prognosis. The purpose of this article is to review the progression of tumor response assessments from CT- and PET/CT-based quantitative and semi-quantitative systems to PET/CT-based qualitative systems; introduce the classification schema for these systems; and describe how to use these rapid, powerful, and qualitative PET/CT-based systems in daily practice through illustrative cases.
Collapse
Affiliation(s)
- J G Peacock
- From the Department of Radiology (J.G.P., K.P.B.), Brooke Army Medical Center, San Antonio, Texas
| | - C T Christensen
- Department of Radiology (C.T.C.), Wilford Hall Ambulatory Surgical Center, San Antonio, Texas
| | - K P Banks
- From the Department of Radiology (J.G.P., K.P.B.), Brooke Army Medical Center, San Antonio, Texas
- Department of Radiology (K.P.B.), Uniformed Services University of the Health Sciences, Bethesda, Maryland
| |
Collapse
|
13
|
Zhou Y, Zhao Z, Li J, Zhang B, Sang S, Wu Y, Deng S. Prognostic values of baseline, interim and end-of therapy 18F-FDG PET/CT in patients with follicular lymphoma. Cancer Manag Res 2019; 11:6871-6885. [PMID: 31413633 PMCID: PMC6662523 DOI: 10.2147/cmar.s216445] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2019] [Accepted: 07/05/2019] [Indexed: 12/11/2022] Open
Abstract
Purpose In the present study, we aimed to investigate the role of baseline, interim and end-of treatment positron emission tomography/computed tomography (PET/CT) in assessing the prognosis of follicular lymphoma (FL). Methods A total of 84 FL patients were retrospectively analyzed in this study. Baseline (n=59), interim (n=24, after 2–4 cycles) and end-of treatment (n=43) PET/CT images were re-evaluated, and baseline maximum standardized uptake value (SUVmax), total metabolic tumor volume (tMTV) and total lesion glycolysis (TLG) were recorded. Interim (I-PET) and end-of treatment (E-PET) PET/CT responses were interpreted by Deauville five-point scale (D-5PS) and International Harmonization Project criteria (IHP). Survival curves were calculated by Kaplan-Meier curves, and differences between groups were compared by log-rank test. Results The 2-year progression-free survival (PFS) of the high- and low-TLG groups was 57.14% and 95.56%, respectively (p=0.0001). The 2-year overall survival (OS) of the high- and low-TLG groups was 62.50% and 100%, respectively (p<0.0001). Multivariate analysis showed that TLG was an independent prognostic factor for PFS (p=0.001, HR=6.577, 95% CI=2.167–19.960) and OS (p=0.030, HR=19.291, 95% CI =2.689–137.947). Besides, Eastern Cooperative Oncology Group (ECOG) was the independent prognostic factor for OS (HR=8.924, 95% CI=1.273–62.559, p=0.028). Interim PET results based on D-5PS or IHP criteria were not significantly correlated with PFS (all p>0.05). However, E-PET results using D-5PS and IHP criteria were statistically significant (p=0.0001 and p=0.006). The D-5PS showed stronger prognostic value compared with IHP criteria. The optimal cutoff value of ΔSUVmax% was 66.95% according to I-PET and 68.97% according to E-PET. However, only the ΔSUVmax% from the baseline to the end-of therapy yielded statistically significant results in the prediction of PFS (p=0.0002). Conclusion Our findings indicated that the baseline TLG and E-PET results were significantly associated with prognosis in patients with FL.
Collapse
Affiliation(s)
- Yeye Zhou
- Department of Nuclear Medicine, The First Affiliated Hospital of Soochow University, Suzhou, People's Republic of China
| | - Zixuan Zhao
- Department of Nuclear Medicine, The First Affiliated Hospital of Soochow University, Suzhou, People's Republic of China
| | - Jihui Li
- Department of Nuclear Medicine, The First Affiliated Hospital of Soochow University, Suzhou, People's Republic of China
| | - Bin Zhang
- Department of Nuclear Medicine, The First Affiliated Hospital of Soochow University, Suzhou, People's Republic of China
| | - Shibiao Sang
- Department of Nuclear Medicine, The First Affiliated Hospital of Soochow University, Suzhou, People's Republic of China
| | - Yiwei Wu
- Department of Nuclear Medicine, The First Affiliated Hospital of Soochow University, Suzhou, People's Republic of China
| | - Shengming Deng
- Department of Nuclear Medicine, The First Affiliated Hospital of Soochow University, Suzhou, People's Republic of China
| |
Collapse
|
14
|
18F-FDG PET/CT for Prognostic Stratification of Patients With Extranodal Natural Killer/T-Cell Lymphoma. Clin Nucl Med 2019; 44:201-208. [PMID: 30624268 DOI: 10.1097/rlu.0000000000002440] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
PURPOSE The prognostic value of PET/CT for extranodal natural killer/T-cell lymphoma (ENKTL) patients is controversial. We sought to investigate the use of pretreatment and interim PET/CT in this disease. METHODS Sixty-five patients diagnosed with ENKTL who underwent pretreatment (n = 53) and/or interim PET/CT scans (after 2-4 cycles of chemotherapy and/or radiotherapy, n = 33) were retrospectively enrolled. Interim PET/CT images were interpreted according to the Deauville 5-point scale. PET/CT results were assessed for their predictive value of progression-free survival (PFS) and overall survival (OS). Kaplan-Meier estimates were generated to evaluate the predictive value of clinical parameters and PET/CT scans for prognosis evaluation. The Cox proportional hazards model was performed to assess the potential independent predictors for PFS and OS. RESULTS Patients with a high score (4/5) according to the Deauville scale had heavier tumor burdens and tended to have elevated serum LDH and β2-microglobulin (β2-MG). In univariate analysis, the following parameters were predictive of PFS: age (≤60 vs > 60 years), stage (I/II vs III/IV), lesion location (nasal vs extranasal), LDH (normal vs elevated), β2-MG (normal vs elevated), SUVmax before treatment (≤8.3 vs > 8.3), and interim PET/CT results. For OS, the predictive factors were composed of stage, lesion location, LDH, β2-MG, and interim PET/CT results. However, in multivariate analysis, only interim PET/CT scan interpreted by the Deauville scale remained as an independent predictor for both PFS and OS. CONCLUSIONS Interim PET/CT scan displayed potential predictive value for ENKTL patients. Response assessment according to the Deauville 5-point scale may help to improve the accuracy of prediction. Patients with advanced stage (III/IV), elevated LDH or β2-MG, and a high Deauville score of 4 to 5 on the interim PET/CT scan were more likely to have reduced PFS and OS.
Collapse
|
15
|
Ding JJ, Chen YL, Zhou SH, Zhao K. Positron emission tomography/computed tomography in the diagnosis, staging, and prognostic evaluation of natural killer/T-cell lymphoma. J Int Med Res 2018; 46:4920-4929. [PMID: 30328364 PMCID: PMC6300951 DOI: 10.1177/0300060518804375] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Natural killer/T-cell lymphoma (NKTL) is a rare subtype of non-Hodgkin's lymphoma that is associated with Epstein-Barr virus infection. The clinicopathological features of NKTL are unique among lymphomas. NKTL is an aggressive disease with a poor prognosis in the absence of effective treatment. Accurate diagnosis and staging are essential to ensure an appropriate treatment strategy and accurate prognosis of NKTL. 18F-Fluorodexoyglucose-positron emission tomography/computed tomography (18F-FDG PET/CT) is a valuable technique in the diagnosis, staging, and prognostic evaluation of various types of malignant tumors, including NKTL. PET/CT imaging studies of patients with NKTL have shown that NKTL is 18F-FDG-avid and that PET/CT is superior to conventional methods in detecting cutaneous and extracutaneous lesions. We herein review recent PET/CT studies that have provided considerable insight into the diagnosis, staging, prognostic evaluation, and treatment effectiveness in patients with NKTL.
Collapse
Affiliation(s)
- Jian-Jun Ding
- 1 Department of Otolaryngology, The First Affiliated Hospital, College of Medicine, Zhejiang University, Zhejiang Province, China.,2 Department of Otolaryngology, The First People's Hospital of Linhai City, Zhejiang Province, China
| | - Ya-Lian Chen
- 1 Department of Otolaryngology, The First Affiliated Hospital, College of Medicine, Zhejiang University, Zhejiang Province, China
| | - Shui-Hong Zhou
- 1 Department of Otolaryngology, The First Affiliated Hospital, College of Medicine, Zhejiang University, Zhejiang Province, China
| | - Kui Zhao
- 3 Department of PET/CT, The First Affiliated Hospital, College of Medicine, Zhejiang University, Zhejiang Province, China
| |
Collapse
|
16
|
Wang H, Shen G, Jiang C, Li L, Cui F, Tian R. Prognostic value of baseline, interim and end-of-treatment 18F-FDG PET/CT parameters in extranodal natural killer/T-cell lymphoma: A meta-analysis. PLoS One 2018; 13:e0194435. [PMID: 29558489 PMCID: PMC5860776 DOI: 10.1371/journal.pone.0194435] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2017] [Accepted: 03/04/2018] [Indexed: 02/05/2023] Open
Abstract
METHODS We searched the PubMed, EMBASE, Cochrane Library and Medline databases for eligible articles. SUVmax, MTV, and TLG on B-PET/CT, DS on I-PET/CT and DS on E-PET/CT were regarded as efficacy data. Combined hazard ratios (HRs) for progression-free survival (PFS) and overall survival (OS) were estimated using RevMan 5.3 software. RESULTS Nine trials with a total of 535 ENKTL patients were included. SUVmax, MTV and TLG on B-PET/CT were significantly associated with PFS with HRs of 2.78 (95%CI 1.54-5.03), 3.61 (95%CI 1.96-6.65) and 5.62 (95%CI 1.94-16.33), respectively, and with OS with HRs of 4.78 (95%CI 2.29-9.96), 3.20 (95%CI 1.55-6.60) and 7.76 (95%CI 1.79-33.58), respectively. For the DS on I-PET/CT, the HRs for PFS and OS were 5.15 (95%CI 2.71-9.80) and 5.80 (95%CI 2.28-14.73), respectively. Similarly, the DS on E-PET/CT was a significant predictor of PFS and OS with HRs of 3.65 (95%CI 2.13-6.26) and 3.32 (95%CI 1.79-6.15), respectively. CONCLUSION Our results suggest that SUVmax, MTV, TLG on B-PET/CT, DS on I-PET/CT and DS on E-PET/CT may be significant prognostic indicators for PFS and OS in ENKTL patients. Moreover, TLG tends to be superior to SUVmax and MTV on B-PET/CT for predicting survival of ENKTL patients. Therefore, response monitoring and prognostication assessments based on multiple PET/CT parameters should be considered in the management of ENKTL patients.
Collapse
Affiliation(s)
- Hongxi Wang
- Department of Nuclear Medicine, West China Hospital of Sichuan University, Chengdu, Sichuan Province, China
| | - Guohua Shen
- Department of Nuclear Medicine, West China Hospital of Sichuan University, Chengdu, Sichuan Province, China
| | - Chong Jiang
- Department of Nuclear Medicine, West China Hospital of Sichuan University, Chengdu, Sichuan Province, China
| | - Li Li
- Department of Nuclear Medicine, West China Hospital of Sichuan University, Chengdu, Sichuan Province, China
| | - Futao Cui
- Department of Nuclear Medicine, West China Hospital of Sichuan University, Chengdu, Sichuan Province, China
| | - Rong Tian
- Department of Nuclear Medicine, West China Hospital of Sichuan University, Chengdu, Sichuan Province, China
| |
Collapse
|
17
|
|
18
|
Jiang M, Chen P, Ruan X, Xu W, Li T, Wu L, Zhou W, Wu H, Wang Q. Interim 18F-FDG PET/CT and BCL2 for predicting the prognosis of patients with diffuse large B-cell lymphoma in the rituximab era. Nucl Med Commun 2017; 39:147-153. [PMID: 29189488 DOI: 10.1097/mnm.0000000000000784] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE In this study, we investigated the prognostic role of interim fluorine-18-fluorodeoxyglucose PET/computed tomography (I-PET/CT) and BCL2 in diffuse large B-cell lymphoma (DLBCL) patients treated with rituximab-containing chemotherapy. MATERIALS AND METHODS A total of 106 patients with newly diagnosed DLBCL underwent PET/CT scans at baseline and a subsequent I-PET/CT after the fourth cycle of chemotherapy. I-PET/CT was analyzed using the Deauville five-point score. The prognostic significance of I-PET/CT and BCL2 was evaluated by predicting progression-free survival (PFS) and overall survival (OS). RESULTS With a median follow-up of 25 months, the 2-year PFS and OS were 78 and 95% in the I-PET/CT-negative group and 33 and 57% in the I-PET/CT-positive group (P<0.001). Patients with BCL2 positivity showed a shorter PFS than the BCL2-negative patients (P=0.002), but not in OS (P=0.068). In multivariate analysis, I-PET/CT and BCL2 were independent variables in assessing the outcome of PFS. I-PET/CT was also an independent factor for OS. Irrespective of the results of BCL2, patients with I-PET/CT positivity had a significant inferior outcome than the I-PET/CT-negative patients. In the I-PET/CT-negative group, patients with BCL2 positivity had a significantly shorter PFS than the BCL2-negative patients (P=0.005). CONCLUSION I-PET/CT and BCL2 were two significant independent indicators of outcome for patients with DLBCL in the rituximab era. I-PET/CT was much better than BCL2 for patient stratification. BCL2 showed its supplementary role for further patient stratification when I-PET/CT was negative.
Collapse
Affiliation(s)
- Maoqing Jiang
- Department of Nanfang PET Center, Nanfang Hospital, Southern Medical University, Guangzhou.,Department of Nuclear Medicine
| | - Ping Chen
- Department of Nephrology, Ningbo First Hospital, Ningbo, Zhejiang, China
| | | | | | | | | | - Wenlan Zhou
- Department of Nanfang PET Center, Nanfang Hospital, Southern Medical University, Guangzhou
| | - Hubing Wu
- Department of Nanfang PET Center, Nanfang Hospital, Southern Medical University, Guangzhou
| | - Quanshi Wang
- Department of Nanfang PET Center, Nanfang Hospital, Southern Medical University, Guangzhou
| |
Collapse
|
19
|
Chang Y, Fu X, Sun Z, Xie X, Wang R, Li Z, Zhang X, Sheng G, Zhang M. Utility of baseline, interim and end-of-treatment 18F-FDG PET/CT in extranodal natural killer/T-cell lymphoma patients treated with L-asparaginase/pegaspargase. Sci Rep 2017; 7:41057. [PMID: 28117395 PMCID: PMC5259805 DOI: 10.1038/srep41057] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2016] [Accepted: 12/15/2016] [Indexed: 01/26/2023] Open
Abstract
Positron emission tomography-computed tomography (PET/CT) is widely used for initial staging and monitoring treatment responses in Hodgkin and diffuse large B-cell lymphoma. However, its prognostic value in extranodal natural killer (NK)/T-cell lymphoma (ENKL) remains unclear. Here, we conducted a retrospective study to determine the impact of PET/CT in ENKL. Fifty-two patients newly diagnosed with ENKL were enrolled. Baseline maximum standardized uptake values (SUVmax), whole-body metabolic tumor volume (WBMTV) and whole-body total lesion glycolysis (WBTLG) were recorded. Additionally, interim PET/CT (I-PET) and end-of-treatment PET/CT (E-PET) results were scored using a 5-point scale. Patients were divided into groups using baseline parameter cut-off values; significant differences were found in overall survival (OS) and progression-free survival (PFS) between the high and low WBMTV and WBTLG groups and in OS between the two SUVmax groups. Positive I-PET and E-PET results predicted inferior PFS and OS. A multivariate analysis showed that baseline WBTLG, I-PET and E-PET results were associated with PFS and OS, and baseline SUVmax was an independent predictor of OS. Thus, baseline WBTLG, I-PET and E-PET results are good predictors of PFS and OS in ENKL patients who received L-asparaginase/pegaspargase in their first-line treatment, and baseline SUVmax is a valuable tool for assessing OS.
Collapse
Affiliation(s)
- Yu Chang
- Department of Oncology, the First Affiliated Hospital of Zhengzhou University, No. 1 Jianshe East Road, Zhengzhou, 450052, China
| | - Xiaorui Fu
- Department of Oncology, the First Affiliated Hospital of Zhengzhou University, No. 1 Jianshe East Road, Zhengzhou, 450052, China
| | - Zhenchang Sun
- Department of Oncology, the First Affiliated Hospital of Zhengzhou University, No. 1 Jianshe East Road, Zhengzhou, 450052, China
| | - Xinli Xie
- Department of nuclear medicine, the First Affiliated Hospital of Zhengzhou University, No. 1 Jianshe East Road, Zhengzhou, 450052, China
| | - Ruihua Wang
- Department of nuclear medicine, the First Affiliated Hospital of Zhengzhou University, No. 1 Jianshe East Road, Zhengzhou, 450052, China
| | - Zhaoming Li
- Department of Oncology, the First Affiliated Hospital of Zhengzhou University, No. 1 Jianshe East Road, Zhengzhou, 450052, China
| | - Xudong Zhang
- Department of Oncology, the First Affiliated Hospital of Zhengzhou University, No. 1 Jianshe East Road, Zhengzhou, 450052, China
| | - Guangyao Sheng
- Department of Pediatrics, the First Affiliated Hospital of Zhengzhou University, No. 1 Jianshe East Road, Zhengzhou, 450052, China
| | - Mingzhi Zhang
- Department of Oncology, the First Affiliated Hospital of Zhengzhou University, No. 1 Jianshe East Road, Zhengzhou, 450052, China
| |
Collapse
|
20
|
Can Interim 18F-FDG PET or Diffusion-Weighted MRI Predict End-of-Treatment Outcome in FDG-Avid MALT Lymphoma After Rituximab-Based Therapy?: A Preliminary Study in 15 Patients. Clin Nucl Med 2017; 41:837-843. [PMID: 27648705 DOI: 10.1097/rlu.0000000000001395] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
PURPOSE To determine whether interim F-FDG PET or interim diffusion-weighted magnetic resonance imaging (DWI) can predict the end-of-treatment (EOT) outcome after immunotherapy in patients with FDG-avid extranodal marginal zone B-cell lymphoma of the mucosa-associated lymphoid tissue (MALT). MATERIALS AND METHODS Patients with untreated MALT lymphoma prospectively underwent whole-body F-FDG PET/CT and DWI before treatment (baseline), and after three cycles (interim) of rituximab-based immunotherapy. Maximum and mean standardized uptake values (SUVmax, SUVmean), and minimum and mean apparent diffusion coefficients (ADCmin, ADCmean), were measured for up to three target lesions per patient. Rates of change between baseline and interim examinations (ΔSUVmax, ΔSUVmean, ΔADCmin, and ΔADCmean) were compared, using ANOVAs, between the four end-of-treatment (EOT, after six cycles of immunotherapy) outcomes: complete remission (CR), partial remission (PR), stable disease (SD), or progressive disease (PD). RESULTS Fifteen patients with 25 lesions were included. Lesion-based post hoc tests showed significant differences between CR and PR for ΔSUVmax (P < 0.001), ΔSUVmean (P < 0.001), and ΔADCmin (P = 0.044), and between CR and SD for ΔSUVmax (P < 0.001), ΔSUVmean (P < 0.001), ΔADCmin (P = 0.021), and ΔADCmean (P = 0.022). No lesion showed PD at EOT. CONCLUSIONS Both quantitative interim F-FDG PET and interim DWI may possibly be useful to predict complete remission at end-of-treatment in MALT lymphoma patients after immunotherapy.
Collapse
|
21
|
Yang SR, Lan XL. [Value of PET-CT clinical application in extranodal NK/T cell lymphoma]. ZHONGHUA XUE YE XUE ZA ZHI = ZHONGHUA XUEYEXUE ZAZHI 2016; 37:1094-1099. [PMID: 28088979 PMCID: PMC7348500 DOI: 10.3760/cma.j.issn.0253-2727.2016.12.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Affiliation(s)
| | - X L Lan
- Department of Nuclear Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology; Hubei Province Key Laboratory of Molecular Imaging, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China
| |
Collapse
|
22
|
Burkitt Lymphoma Presented as Acute Lower Back Pain and Revealed by 18F-NaF PET/CT. Clin Nucl Med 2016; 41:e253-4. [DOI: 10.1097/rlu.0000000000001109] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
|