Prognostic value of positron emission tomography (PET) with fluorine-18 fluorodeoxyglucose ([<script type="math/tex">^{18}F</script>]FDG) after first-line chemotherapy in non-Hodgkins lymphoma : is [<script type="math/tex">^{18}F</script>]FDG-PET a valid alternative to conventional diagnostic methods?

Spaepen, Karoline; Stroobants, Sigrid; Dupont, Patrick; et al.

doi:10.1200/JCO.2001.19.2.414

Title

Prognostic value of positron emission tomography (PET) with fluorine-18 fluorodeoxyglucose ([ $^{18}F$ ]FDG) after first-line chemotherapy in non-Hodgkins lymphoma : is [ $^{18}F$ ]FDG-PET a valid alternative to conventional diagnostic methods?

Author

Spaepen, Karoline

Stroobants, Sigrid

Dupont, Patrick

et al.

Abstract

PURPOSE: A complete remission (CR) after first-line therapy is associated with longer progression-free survival (PFS). However, defining CR is not always easy because of the presence of residual masses. Metabolic imaging with fluorine-18 fluorodeoxyglucose ([18F]FDG) positron emission tomography (PET) offers the ability to differentiate between viable and fibrotic inactive tissue. In this study, we evaluated the value of PET in detecting residual disease and, hence, predicting relapse after first-line treatment in patients with non-Hodgkins lymphoma (NHL). PATIENTS AND METHODS: Ninety-three patients with histologically proven NHL, who underwent a whole-body [18F]FDG-PET study after completion of first-line chemotherapy and who had follow-up of at least 1 year, were included. Persistence or absence of residual disease on PET was related to PFS using Kaplan-Meier survival analysis. RESULTS: Sixty-seven patients showed a normal PET scan after first-line chemotherapy; 56 of 67 remained in CR, with a median follow-up of 653 days. Nine of these patients with a residual mass considered as unconfirmed CR received additional radiotherapy. Only 11 of 67 patients relapsed (median PFS, 404 days). Persistent abnormal [18F]FDG uptake was seen in 26 patients, and all of them relapsed (median PFS, 73 days). Because standard restaging also suggested residual disease, 12 patients received immediate secondary treatment. In 14 of 26 patients, only PET predicted persistent disease. From these patients, relapse was proven either by biopsy (n = 8) or by progressive disease on computed tomography or magnetic resonance imaging (n = 6). CONCLUSION: Persistent abnormal [18F]FDG uptake after first-line chemotherapy in NHL is highly predictive for residual or recurrent disease. In relapsing patients, PFS was significantly shorter after a positive scan than after a negative scan.

Language

English

Source (journal)

Journal of clinical oncology. - New York

Publication

New York : 2001

ISSN

0732-183X

DOI

10.1200/JCO.2001.19.2.414

Volume/pages

19 :2 (2001) , p. 414-419