Artikel
Functional diagnosis of residual lymphomas after radiochemotherapy with positron emission tomography
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Autoren
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Patrick Wuchter
- Universitätsklinikum Heidelberg, Abtlg. Innere Med. V, Deutschland
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Bernd Kasper
- Universitätsklinikum Heidelberg, Abtlg. Innere Med. V
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Thomas Lehnert
- Klinikum Bremen-Mitte, Kliniken für Allgemeine, Viscerale, Onkologische und Gefäßchirurgie
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Anthony D. Ho
- Universitätsklinikum Heidelberg, Abtlg. Innere Med. V
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Uwe Haberkorn
- Universitätsklinikum Heidelberg, Radiologische Klinik
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Gerlinde Egerer
- Universitätsklinikum Heidelberg, Abtlg. Innere Med. V
| Veröffentlicht: | 20. März 2006 |
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Gliederung
Text
Introduction: The clinical value of residual tissue after radiochemotherapy for the outcome and prognosis of patients with lymphoma is still uncertain. Positron emission tomography (PET) using 2-deoxy-2-[18F]fluoro-D-glucose (FDG) is used as a functional imaging technique in the staging and follow-up of lymphomas. However, additional information about the tumor proliferation rate using 3'-deoxy-3'-[18F]fluorothymidine (FLT) may be useful for the assessment of prognosis.
Methods: We enrolled 61 patients with Hodgkin’s (n = 17) as well as low-grade (n = 13) and high-grade (n = 31) non-Hodgkins’s lymphoma after end of chemotherapy and/or radiotherapy treatment with residual masses > 2 cm using FDG- and FLT-PET. 22 patients were female, 39 patients were male. Median age was 46.1 years [range: 18 – 77]. Localisation of residual lymphoma / mass were as follows: 35 patients supradiaphragmal, 22 patients infradiaphragmal and in four patients residual masses were found on both sides of the diaphragma. Dual tracer studies with FDG and FLT were performed in 48 patients. Results were related to median overall and progression-free survival.
Results: In 21 out of 61 patients analysed using FDG positive results were found. Using FLT, 10 out of 48 patients were positive. 31 patients were negative, eight patients were positive both using FDG and FLT. Overall survival for patients with negative PET is significantly higher than for patients with positive PET, irrespective of the tracer used. FLT alone was able to discriminate between patients with long or short overall survival. There was also a statistical significance comparing FDG/FLT negative versus FDG negative alone (p = 0.001).
Conclusions: PET scanning undoubtedly is valuable in the assessment of response and is the most useful non-invasive modality in differentiating between residual tumour and fibrosis. Whereas FDG detected more lesions than FLT, the additional biological characterization of tumor tissue with respect to tumor proliferation by FLT represents a valuable tool for the prediction of survival.
