Hodgkin's disease: the next decade

Positron emission tomography in the evaluation of lymphoma

Positron emission tomography (PET) using (18)F-fluoro-deoxyglucose (FDG) has emerged in recent years as an important tool for the evaluation of lymphoma patients during their course of disease. At diagnosis, FDG imaging is capable of detecting nodal and extra nodal sites of disease and provides accurate staging. FDG-PET is superior to computed tomography, during and at the end of first-line treatment or salvage therapeutic regimens, as a tool for monitoring therapeutic response. PET enables the differential diagnosis of residual viable tumor versus a remnant fibrotic or necrotic mass. PET also provides prognostic data of high clinical significance for both Hodgkin's disease and non-Hodgkin's lymphoma. Results of this metabolic imaging modality, interpreted in view of the pretherapy risk profile of the individual patient, are predictive of the immediate success of a certain therapeutic strategy, as well as of overall and disease-free survival. PET appears to play also an important role in the detection of lymphoma relapse. Data comparing (67)Gallium scintigraphy and FDG-PET indicate the latter as the functional imaging modality of choice for assessment of lymphoma patients. Preliminary studies show an additional value of fused PET/computed tomography imaging for further improved diagnosis, staging and definition of status of lymphoma.

Radionuclide evaluation of patients with lymphoma

Nuclear medicine imaging techniques allow us to peer into physiologic processes, avoiding the need to wait until anatomic changes are detectable, and allowing for prompt, informed management decisions. Recognition of normal, abnormal, and post-therapy scan patterns is critical to achieve the necessary sensitivity and specificity needed for patient management. Gallium scintigraphy using updated techniques has an important continuing role in management of patients with lymphoma. Gallium scintigraphy can contribute to patient management primarily by detecting residual disease or relapse after treatment, monitoring response during therapy, and providing prognostic information. FDG and PET cameras, especially dedicated ring systems, offer high resolution and high-contrast images, thereby demonstrating additional sites of disease. Although preliminary evidence looks promising that FDG can provide all information that Ga-67 has been shown to do in the past, additional data are required. Further studies will show whether FDG-PET can provide prognostic information and predict disease-free and overall survival, the availability of both FDG and PET scanners, and issues of cost. Patient accessibility will undoubtedly also play a role in when, or whether, FDG-PET will totally replace Ga-67 scintigraphy in the management of patients with lymphoma.

Hodgkin's disease in 82 Turkish children diagnosed over a 10-year period: epidemiological, clinical, and histopathologic features and prognosis with prolonged chemotherapy

In this study, 82 Turkish children with Hodgkin's disease (HD) between 1 and 14 years of age and diagnosed over a 10-year period were evaluated retrospectively. More than half of the patients (54%) presented with advanced stages of HD. Mixed cellularity (MC) was the most frequent (56.1%) histopathologic type, which was followed by nodular sclerosing (NS, 18.3%) in frequency. None of the patients received radiotherapy as initial treatment. In 67 children the COPP regimen alone and in 15 the ABVD regimen alternating with COPP were started, to be given as a total of 12 courses. In the patients who presented with stage I-II HD the overall survival (OAS) rate and 5-year event free survival (EFS) rate were 92.3% and 77.8%, respectively. In the patients with advanced disease (stage III-IV) OAS and 5-year EFS were estimated to be 89.5% and 67.4%, respectively. No serious toxicity of chemotherapy was detected during the follow-up. In this group, clinical, epidemiological and histopathologic features of the disease showed a special pattern close to the type I pattern of HD. Regarding the survival rules and occurrence of low toxicity in our patients, results of prolonged chemotherapy alone seem to be encouraging in most of the children with HD. However, the follow-up duration is not yet sufficient to declare a clear conclusion related to the late complications.