Der Nuklearmediziner 2013; 36(02): 79-85
DOI: 10.1055/s-0033-1345111
Lymphome: Diagnostik und Therapie
© Georg Thieme Verlag KG Stuttgart · New York

Early Interim PET/CT beim Hodgkin-Lymphom des Erwachsenen – Von der Risikostratifizierung zur Therapiestratifizierung

Early Interim PET/CT in Hodgkin Lymphoma of Adults – From Risk Stratification to Therapy Stratification
M. Dietlein
1   Klinik und Poliklinik für Nuklearmedizin, Universitätsklinikum Köln, Deutschland
,
G. Kuhnert
1   Klinik und Poliklinik für Nuklearmedizin, Universitätsklinikum Köln, Deutschland
,
D. Kahraman
1   Klinik und Poliklinik für Nuklearmedizin, Universitätsklinikum Köln, Deutschland
,
A. Engert
2   Klinik I für Innere Medizin, Universitätsklinikum Köln, Deutschland
3   German Hodgkin Study Group (GHSG), Universitätsklinikum Köln, Deutschland
,
P. Borchmann
2   Klinik I für Innere Medizin, Universitätsklinikum Köln, Deutschland
3   German Hodgkin Study Group (GHSG), Universitätsklinikum Köln, Deutschland
,
M. Fuchs
2   Klinik I für Innere Medizin, Universitätsklinikum Köln, Deutschland
3   German Hodgkin Study Group (GHSG), Universitätsklinikum Köln, Deutschland
,
C. Baues
4   Klinik und Poliklinik für Strahlentherapie, Universitätsklinikum Köln, Deutschland
,
H. Eich
5   Klinik und Poliklinik für Strahlentherapie, Universitätsklinikum Münster, Deutschland
,
A. Drzezga
1   Klinik und Poliklinik für Nuklearmedizin, Universitätsklinikum Köln, Deutschland
,
C. Kobe
1   Klinik und Poliklinik für Nuklearmedizin, Universitätsklinikum Köln, Deutschland
› Author Affiliations
Further Information

Publication History

Publication Date:
24 June 2013 (online)

Zusammenfassung

Die PET/CT beim Hodgkin-Lymphom, durchgeführt bereits nach wenigen Zyklen Chemotherapie als Early Interim PET/CT, unterscheidet zwischen Patienten mit günstiger und ungünstiger Prognose. Basierend auf dieser Erkenntnis untersuchen zahlreiche laufende Studien, ob bei Patienten mit günstiger Prognose weniger Chemotherapie zu gleichwertigen Überlebensraten führt bzw. ob bei Patienten mit ungünstiger Prognose die Überlebensraten verbessert werden können. Bei den hohen Heilungsraten des Hodgkin-Lymphoms ist die Anzahl der zu beobachtenden Ereignisse klein. Das macht hohe Rekrutierungszahlen erforderlich, um eine statistische Signifikanz zu erreichen. Outcome-Daten mit hohem Evidenzgrad liegen daher noch nicht vor. Die Verwendung einheitlicher Scores bei der Referenzbeurteilung zur Beschreibung der FDG-Speicherintensität im Restgewebe ist eine Vor­aussetzung, um später die Ergebnisse der verschiedenen internationalen Studien vergleichen zu können. Neben dieser Studienfrage einer PET-basierten Deeskalation bzw. Therapie-Eskalation wird die Early Interim PET/CT eingesetzt, um Pa­tienten mit Progress oder fehlendem Therapieansprechen frühzeitig von einer unwirksamen Therapie auszuschließen und individualisiert einer anderen Therapie zuzuführen.

Abstract

PET/CT in Hodgkin lymphoma, performed after few cycles of chemotherapy as early interim PET/CT, has shown a high predictive value for progression free survival (PFS). Many ongoing clinical trials evaluate whether a reduction of chemotherapy in PET-negative patients will offer an equivalent PFS, or whether an intensification of chemotherapy in PET-positive patients will improve PFS, respectively. The number of events is low as the cure rate in Hodgkin lymphoma is high. Therefore, high numbers of recruited patients are necessary to reach statistical significance. Data on outcome are not yet available. The use of comparable scores in the central review process to describe the intensity of FDG-accumulation in residual tissue is necessary to compare the results of the different international trials in the future. Additionally, early interim PET/CT is used to exclude patients with therapeutic failure or progress from an ineffective therapy as early as possible and to change management individually.

 
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