Advances in Clinical and Experimental Medicine

Title abbreviation: Adv Clin Exp Med
JCR Impact Factor (IF) – 1.736
5-Year Impact Factor – 2.135
Index Copernicus  – 168.52
MEiN – 70 pts

ISSN 1899–5276 (print)
ISSN 2451-2680 (online)
Periodicity – monthly

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Advances in Clinical and Experimental Medicine

2016, vol. 25, nr 6, November-December, p. 1185–1192

doi: 10.17219/acem/62652

Publication type: original article

Language: English

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Positron Emission Tomography Scanning in the Management of Hodgkin Lymphoma Patients: A Single-Institution Experience

Ewa Zabrocka1,A,B,C,D,F, Ewa Sierko1,A,B,E,F, Marek Z. Wojtukiewicz1,E,F

1 Department of Oncology, Medical University of Białystok, Poland

Abstract

Background. Positron emission tomography (PET-CT) has become a valuable implement in the management of Hodgkin lymphoma (HL). However, since PET-CT is a relatively new imaging method, its capabilities have not been fully explored.
Objectives. The aim of the study was to evaluate the role of PET-CT at different points in HL management.
Material and Methods. The medical documentation of 47 HL patients treated at the Comprehensive Cancer Center in Białystok, Poland, was analyzed retrospectively. The study group consisted of 15 men and 32 women, aged 18–59 years, in HL clinical stages II–IV, treated either with chemotherapy or sequential chemoradiotherapy.
Results. In 65.2% of the patients who underwent post-chemotherapy PET-CT scanning before their qualification for adjuvant radiotherapy (RT), PET-CT was decisive in qualifying them for RT, by establishing whether or not metabolic partial remission (PR) had occurred. With regard to the achievement of partial or complete response (CR), computed tomography (CT) and PET-CT results correlated in 45.5% of the patients after the completion of chemotherapy, and in 18.7% after the completion of the entire treatment (chemotherapy or chemoradiotherapy). Among the patients from the advanced-stage group (stages III/IV stage and/or bulky HL), morphological PR in CT scans after two to three courses of chemotherapy was more often associated with a lack of metabolic CR in posttreatment PET-CT scanning (p = 0.022) than in other patients. Post-treatment PET-CT scanning was shown to be highly prognostic of a relapse-free follow-up (p < 0.0001) and superior to post-treatment CT imaging in relapse prediction (p < 0.0001).
Conclusion. Compared to CT, PET-CT was more accurate in residual masses assessment. Notable ability of PET-CT in relapse-free follow-up prediction encourages to more common use of PET-CT in clinical practice. Further clinical research on the need for RT in patients with PR in CT parallel to CR in PET-CT is required.

Key words

computed tomography, Hodgkin lymphoma, positron emission tomography, residual masses

References (25)

  1. Jemal A, Siegel R, Ward E, Hao Y, Xu J, Thun MJ: Cancer Statistics 2009. CA Cancer J Clin 2009, 59, 225–249.
  2. Mauch PM, Kalish LA, Kadin M, Coleman CN, Osteen R, Hellman S: Patterns of presentation of Hodgkin disease. Implications for etiology and pathogenesis. Cancer 1993, 71, 2062–2071.
  3. Gobbi PG, Broglia C, Di Giulio G, Mantelli M, Anselmo P, Merli F, Zinzani PL, Rossi G, Callea V, Iannitto E, Paulli M, Garioni L, Ascari E: The clinical value of tumor burden at diagnosis in Hodgkin lymphoma. Cancer 2004, 101, 1824–1834.
  4. Connors JM: State-of-the-art therapeutics: Hodgkin’s lymphoma. J Clin Oncol 2005, 23, 6400–6408.
  5. Vinnicombe SJ, Reznek RH: Computerised tomography in the staging of Hodgkin’s disease and non-Hodgkin’s lymphoma. Eur J Nucl Med Mol Imaging 2003, 30, 42–55.
  6. Juweid ME: Utility of positron emission tomography (PET) scanning in managing patients with Hodgkin lymphoma. Hematology Am Soc Hematol Educ Program 2006, 2006, 259–265.
  7. Connors JM: Positron emission tomography in the management of Hodgkin lymphoma. Hematology Am Soc Hematol Educ Program 2011, 2011, 317–322.
  8. Juweid ME, Cheson BD: Positron emission tomography and assessment of cancer therapy. N Engl J Med 2006, 354, 496–507.
  9. Juweid ME, Stroobants S, Hoekstra OS, Mottaghy FM, Dietlein M, Guermazi A, Wiseman GA, Kostakoglu L, Scheidhauer K, Buck A, Naumann R, Spaepen K, Hicks RJ, Weber WA, Reske SN, Schwaiger M, Schwartz LH, Zijlstra JM, Siegel BA, Cheson BD: Use of positron emission tomography for response assessment of lymphoma: Consensus of the Imaging Subcommittee of International Harmonization Project in Lymphoma. J Clin Oncol 2007, 25, 571–578.
  10. Hueltenschmidt B, Sautter-Bihl ML, Lang O, Maul FD, Fischer J, Mergenthaler HG, Bihl H: Whole body positron emission tomography in the treatment of Hodgkin disease. Cancer 2001, 91, 302–310.
  11. Hutchings M, Loft A, Hansen M, Pedersen LM, Buhl T, Jurlander J, Buus S, Keiding S, D’Amore F, Boesen AM, Berthelsen AK, Specht L: FDG-PET after two cycles of chemotherapy predicts treatment failure and progressionfree survival in Hodgkin lymphoma. Blood 2006, 107, 52–59.
  12. Eisenhauer EA, Therasse P, Bogaerts J, Schwartz LH, Sargent D, Ford R, Dancey J, Arbuck S, Gwyther S, Mooney M, Rubinstein L, Shankar L, Dodd L, Kaplan R, Lacombe D, Verweij J: New response evaluation criteria in solid tumours: revised RECIST guideline (version 1.1). Eur J Cancer 2009, 45, 228–247.
  13. Hoppe RT, Advani RH, Ai WZ, Ambinder RF, Aoun P, Bello CM, Benitez CM, Bernat K, Bierman PJ, Blum KA, Chen R, Dabaja B, Forero A, Gordon LI, Hernandez-Ilizaliturri FJ, Hochberg EP, Huang J, Johnston PB, Kaminski MS, Khan N, Maloney DG, Mauch PM, Metzger M, Moore JO, Morgan D, Moskowitz CH, Mulroney C, Poppe M, Rabinovitch R, Seropian S, Smith M, Winter JN, Yahalom J, Burns J, Sundar H: NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines). Hodgkin lymphoma. http://www.nccn.org/professionals/ physician_gls/f_guidelines.asp#hodgkin. (Access date: 23.04.2014).
  14. Krzakowski M, Warzocha K: Zalecenia postepowania diagnostyczno-terapeutycznego w nowotworach złośliwych – 2013 rok. Via Medica: Gdańsk 2013, 981–990 [in Polish].
  15. Raanani P, Shasha Y, Perry C, Metser U, Naparstek E, Apter S, Nagler A, Polliack A, Ben-Bassat I, EvenSapir E: Is CT scan still necessary for staging in Hodgkin and non-Hodgkin lymphoma patients in the PET/CT era? Ann Oncol 2006, 17, 117–122.
  16. Eichenauer DA, Engert A, Dreyling M: Hodgkin’s lymphoma: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up. Ann Oncol 2011, 22, 55–58.
  17. Eich HT, Kriz J, Schmidberger H, Böll B, Klimm B, Rancea M, Müller RP, Engert A: The German evidence-based guidelines for Hodgkin’s lymphoma. Aspects for radiation oncologists. Strahlenther Onkol 2013, 189, 445–447.
  18. Engert A, Kobe C, Markova J, Haverkamp H, Borchmann P, Hitz F, Zijlstra J, Eich H, Mueller RP, Dietlein M, Diehl V: Assessment of residual bulky tumor using FDG-PET in patients with advanced-stage Hodgkin Lymphoma after completion of chemotherapy: Final report of the GHSG HD15 trial. ASH annual meeting abstracts 2010, 116, 764.
  19. Savage KJ, Connors JM, Klasa RJ, Hoskins P, Shenkier TN, Gascoyne RD, Bhimji S, Pickles T, Benard F, Wilson D, Sehn LH: The use of FDG-PET to guide consolidative radiotherapy in patients with advanced-stage Hodgkin lymphoma with residual abnormalities on CT scan following ABVD chemotherapy. J Clin Oncol 2011, 29 (Suppl; abstr 8034).
  20. Lammering G, De Ruysscher D, van Baardwijk A, Baumert BG, Borger J, Lutgens L, van den Ende P, Ollers M, Lambin P: The use of FDG-PET to target tumors by radiotherapy. Strahlenther Onkol 2010, 186, 471–481.
  21. El-Galaly TC, Mylam KJ, Brown P, Specht L, Christiansen I, Munksgaard L, Johnsen HE, Loft A, Bukh A, Iyer V, Nielsen AL, Hutchings M: Positron emission tomography/computed tomography surveillance in patients with Hodgkin lymphoma in first remission has a low positive predictive value and high costs. Haematologica 2012, 97, 931–936.
  22. Maeda LS, Horning SJ, Iagaru AH, Lin FI, Hoppe RT, Rosenberg SA, Advani RH: Role of FDG-PET/CT surveillance for patients with classical Hodgkin’s disease in first complete response: The Stanford University experience [Abstract]. Blood 2009, 114, 1563.
  23. Hutchings M: How does PET/CT help in selecting therapy for patients with Hodgkin lymphoma? Hematology Am Soc Hematol Educ Program 2012, 2012, 322–327.
  24. De Wit M, Bohuslavizki KH, Buchert R, Bumann D, Clausen M, Hossfeld DK: 18FDG-PET following treatment as valid predictor for disease-free survival in Hodgkin’s lymphoma. Ann Oncol 2001, 12, 29–37.
  25. Guay C, Lépine M, Verreault J, Bénard F: Prognostic value of PET using 18F-FDG in Hodgkin’s disease for posttreatment evaluation. J Nucl Med 2003, 44, 1225–1231.
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