[18F]fluoro-2-deoxy-D-glucose positron emission tomography (FDG-PET) in aggressive lymphoma: an early prognostic tool for predicting patient outcome

Abstract

Assessment of early therapeutic response using metabolic imaging is potentially useful to determine prognosis in aggressive lymphoma. Between January 2000 and January 2004, 90 patients with newly diagnosed aggressive lymphoma (median age 53 years, 94% diffuse large Bcell) were prospectively explored with [ 18 F]fluoro-2-deoxy-D-glucose positron emission tomography (FDG-PET) prior to induction chemotherapy, after 2 cycles ("early PET"), and after induction completion. Therapeutic response was evaluated using conventional diagnostic methods at 4 cycles. Induction treatment with an anthracycline-containing regimen was administered to all patients, associated with rituximab in 41%. According to the International Prognostic Index (IPI), 37 patients and 53 patients belonged to the lower-and higher-risk groups, respectively. At midinduction, "early PET" was considered negative in 54 patients and positive in 36. After completion of induction, 83% of PET-negative patients achieved complete remission compared with only 58% of PET-positive patients. Outcome differed significantly between PET-negative and PET-positive groups; the 2-year estimates of event-free survival reached 82% and 43%, respectively (P < .001), and the 2-year estimates of overall survival reached 90% and 61%, respectively (P ‫؍‬ .006). Predictive value of "early PET" was observed in both the lower-risk and higher-risk groups, indicating prognostic independence from the IPI. Therefore, FDG-PET should be an early guide to firstline strategies in aggressive lymphoma.

Tumor Burden Assessed by the Maximum Standardized Uptake Value and Greatest Diameter on FDG-PET Predicts Prognosis in Untreated Diffuse Large B-cell Lymphoma

“…The major indication of FDG-PET in NHL was to differentiate between viable tumor tissue and fibrosis after chemotherapy, because complete remission after full cycles of chemotherapy is a determinant of cure in NHL [3,17]. Thereafter, interim evaluation of response during chemotherapy has become a principal reason for conducting FDG-PET in DLBCL [18,19]. The lack of data for prognostic value of pretreatment FDG-PET may lie in multiplicity of lymphoma lesions.…”

Use of PET and PET/CT for Radiation Therapy Planning: IAEA expert report 2006–2007

“…PET commonly influences RT fields in lymphoma by PET is also used to assess the response of lymphomas to CHT [120], either at the end of therapy, or as an interim measure, after e.g. 1-3 cycles [121][122][123][124]. Persistent interim tumor FDG uptake is a powerful negative prognostic factor in patients with…”

Role of 18FDG-PET/CT in detecting relapse during follow-up of patients with Hodgkin’s lymphoma

“…In particular, its role in managing lymphoma patients has grown progressively and its use is now often recommended in disease staging [2][3][4][5], monitoring during therapy [6][7][8][9][10], posttreatment restaging [11][12][13][14][15], and modeling radiotherapy field [16]. Less is known about the role of 18 FDG-PET during follow-up, especially its capability to detect relapse earlier with respect to CT or ultrasound imaging.…”