Radiotherapy in Follicular Lymphoma Staged by 18F-FDG-PET/CT: A German Monocenter Study

Abstract

This retrospective study examined the role of 18F-fluorodeoxyglucose-positron emission tomography/computed tomography (18F-FDG-PET/CT) in stage-related therapy of follicular lymphomas (FL). Twelve patients each in stages I and II, 13 in stage III and 11 in stage IV were treated in the Department of Radiation Oncology, University Hospital of Muenster, Germany from 2004 to 2016. Radiotherapy (RT), as well as additional chemoimmunotherapy were analyzed with a median follow-up of 87.6 months. Ultrasound (US), CT and 18F-FDG-PET/CT were used to determine progression-free survival (PFS), overall survival (OS) and lymphoma-specific survival (LSS) over 5- and 10- years. 23 of 24 patients with stage I/II (95.8%) had complete remissions (CR) and 17 of 24 patients with stages III/IV FL showed CR (70.8%). 5- and 10-year PFS in stages I/II was 90.0%/78.1% vs. 44.3%/28.5% in stages III/IV. 5- and 10-year OS rates in stages I/II was 100%/93.3% vs. 53.7%/48.4% in stages III/IV. 5- and 10-year LSS of stages I/II was 100%/93.8% vs. 69.2%/62.3% in stages III/IV. FL of stages I/II, staged by 18F-FDG-PET/CT, revealed better survival rates and lower risk of recurrence compared to studies without PET/CT-staging. Especially, patients with PET/CT proven stage I disease showed significantly better survival and lower relapses rates after RT.

Involved-Site Radiation Therapy Enables Effective Disease Control in Parenchymal Low-Grade Primary Cerebral Lymphoma

“…However, it is known that lymphoma in general, and especially low-grade lymphoma such as MZBCL or FL, is highly responsive to RT alone [20,21,[27][28][29]. This turned out to be true for parenchymal LG-PCNSL in the patient cohort presented here and is corroborated by the literature [11][12][13][14]16,23,30].…”

New Insights in Radiotherapy

“…Their study showed that involved field radiation combined with immunotherapy is a valuable therapeutic tool for the treatment of early-stage nodal and extranodal follicular lymphomas. 18 F-FDG-PET-CT is an optimal approach for staging, especially in early-stage follicular lymphomas, which enables the identification of patients with excellent prognosis by radiotherapy [ 4 ].…”