Early therapy monitoring with FDG-PET in aggressive non-Hodgkin?s lymphoma and Hodgkin?s lymphoma

Abstract

This study was designed to determine the value of 2-[fluorine-18]-fluoro-2-deoxy- d-glucose positron emission tomography (FDG-PET) in the early assessment of therapy response in lymphoma patients. We studied 20 patients with pathologically proven lymphoma, including 17 patients with aggressive non-Hodgkin's lymphoma and three patients with Hodgkin's lymphoma. All patients underwent whole-body FDG-PET imaging at baseline and after 1-2 cycles of chemotherapy. PET images were analysed visually and quantitatively by calculating the standardised uptake value (SUV). In each patient, we measured the SUV of the tumour demonstrating the highest FDG uptake at baseline study and the SUV of the same tumour after 1-2 cycles of therapy. The achievement of complete response was assessed on the basis of a combination of clinical findings and the results of conventional imaging modalities. Follow-up of progression-free survival (PFS) was obtained for the validation of PET data. Of the 20 patients, ten achieved complete remission at the completion of chemotherapy and the other ten did not respond to chemotherapy. Of the ten responders, four are still in remission (PFS 24-34 months) while the other six have relapsed (PFS 8-16 months). For the prediction of 24-month clinical outcome, visual analysis of PET after 1-2 cycles showed high sensitivity (87.5%) and accuracy (80%) but low specificity (50%). Comparison with the baseline SUVs revealed that the responders showed a significantly greater percent reduction in SUV after 1-2 cycles of therapy as compared with the non-responders (81.2%+/-9.5% vs 35.0%+/-20.2%, P<0.001). In addition, using 60% reduction as a cut-off value, the responders were clearly separated from the non-responders, with the exception of one non-responder. In conclusion, when performed early during chemotherapy, FDG-PET may be predictive of clinical outcome and allows differentiation of responders from non-responders in cases of aggressive lymphoma.

The role of 18F‐FDG PET/CT imaging in Waldenstrom macroglobulinemia

“…FDG-PET imaging was a significant predictor of disease progression, event-free survival and overall survival [11,12,14,16,22,23]. We attempted to assess whether the combination of monoclonal protein response and FDG-PET response can be used to determine subsets of patients with longer progression-free survival.…”

Changes in 18F-FDG Uptake Within Minutes After Chemotherapy in a Rabbit VX2 Tumor Model

“…As a noninvasive tool to monitor the effects of chemotherapy and radiotherapy, 18 F-FDG PET/CT has many unique advantages (20). Many studies have demonstrated that 18 F-FDG PET is sensitive for monitoring the response of tumors early after chemotherapy and radiotherapy (2,(21)(22)(23).…”

Early 18F-FDG PET for Prediction of Prognosis in Patients with Diffuse Large B-Cell Lymphoma: SUV-Based Assessment Versus Visual Analysis

“…PETwi th 18 F-FDG is a well-recognized diagnostic tool used for staging and monitoring response to therapy in most lymphomas (1)(2)(3)(4)(5)(6)(7)(8)(9)(10). The superiority of PET over CT to identify active disease after therapy completion (11)(12)(13) has recently led to revision of response criteria, allowing elimination of the complete remission/unconfirmed category (14).…”