PET/CT zur Therapiekontrolle beim Hodgkin-Lymphom des Erwachsenen: Hängt die Indikation zur Strahlentherapie vom Ergebnis der PET/CT ab?

Zusammenfassung

Die Positronenemissionstomografie (PET) hat eine zunehmende Bedeutung im Therapiemanagement des Hodgkin-Lymphoms. Nach Ende der Chemotherapie zeigt die PET einen hohen negativ prädiktiven Wert. Bei der Behandlung des Hodgkin-Lymphoms werden hohe Heilungsraten erreicht, aber auch Nebenwirkungen durch die Therapie beobachtet. Bietet ein negativer PET-Befund nach Chemotherapie die Möglichkeit, eine individualisierte, responseadaptierte Therapiereduktion zu prüfen? Nach Ende der Chemotherapie wird in großen MulticenterStudien die Möglichkeit geprüft, bei negativer PET auf die Bestrahlung zu verzichten. Die erste große Studie, die den Einsatz der PET zum Bestrahlungsverzicht prüfte, konnte dieses für das fortgeschrittene Hodgkin-Lymphom nach der intensiven Behandlung nach dem BEACOPP_esk Therapieregime als neuen Behandlungsstandard empfehlen. Offen ist die Möglichkeit des Verzichtes auf die Bestrahlung nach weniger intensiven oder anderen Behandlungsregimen und beim frühen oder intermediären Stadium des Hodgkin-Lymphoms.

Abstract

The metabolic response to therapy of Hodgkin lymphoma can be easily seen by a PET scan after chemotherapy. After the end of chemotherapy PET has a very high negative predictive value. As the treatment of advanced stage Hodgkin lymphoma patients reaches high cure rates but has a certain toxicity and side effects, a negative PET scan might offer the chance for an individualized, response adapted reduction of therapy. Therefore, it has been tested in the HD15 trial of the German Hodgkin Study Group to restrict the standard treatment radiotherapy to PET positive patients after chemotherapy. Beside this successful study, after which radiotherapy is being omitted in PET negative patients who have undergone the intensive BEACOPP_esc therapy in advanced stages the use of PET has to be tested after different or less intensive treatment regimens and in early or intermediate stages of disease.

Schlüsselwörter

Hodgkin Lymphom - PET - Therapiekontrolle - Strahlentherapie

Key words

Hodgkin lymphoma - PET - response assessment - radiotherapy

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