Prognostic significance of positron emission tomography using fluorine-18-fluorodeoxyglucose in patients treated for malignant lymphoma

U. Cremerius; U. Fabry; J. Neuerburg; M. Zimny; R. Bares; R. Osieka; U. Bull

doi:10.1055/s-0038-1623988

Nuklearmedizin - NuclearMedicine, Table of Contents

Nuklearmedizin 2001; 40(01): 23-30
DOI: 10.1055/s-0038-1623988

Originalarbeiten – Original Articles

Schattauer GmbH

Prognostic significance of positron emission tomography using fluorine-18-fluorodeoxyglucose in patients treated for malignant lymphoma

Prognostische Bedeutung der Therapiekontrolle durch die Positronen-Emissions-Tomographie mit Fluor-18-Deoxyglukose bei Patienten mit malignen Lymphomen

Authors

U. Cremerius

¹Departments of Nuclear Medicine (Head: Prof. U. Buell, M.D.)
U. Fabry

²Departments of internal Medicine IV (Head: Prof. R. Osieka, M.D.)
J. Neuerburg

³Departments of Diagnostic Radiology (Head: Prof. R. Günther, M.D.), University of Technology, Aachen, Germany
M. Zimny

¹Departments of Nuclear Medicine (Head: Prof. U. Buell, M.D.)
R. Bares

¹Departments of Nuclear Medicine (Head: Prof. U. Buell, M.D.)
R. Osieka

²Departments of internal Medicine IV (Head: Prof. R. Osieka, M.D.)
U. Bull

¹Departments of Nuclear Medicine (Head: Prof. U. Buell, M.D.)

Abstract

Summary

Aim: To evaluate the prognostic significance of positron emission tomography (PET) using fluorine-18-[2]-fluoro-2-deoxyglucose (FDG) in patients treated for Hodgkin’s disease (HD) or nori-Hodgkin’s lymphoma (NHL) compared to conventional restaging (CRS). Methods: Fifty-six patients with either HD (ç = 22), high-grade NHL (n = 26) or centrocyfic-centroblastic NHL (n = 8) were included. PET was performed in 41 patients for treatment reevaluation up to three months after therapy and in patients with persisting residual masses (n = 10) or suspected relapse (n = 5) four to twelve months after treatment. The scans were evaluated qualitatively and quantitatively using standardised uptake values (SUV). Progression-free survival (PFS) was estimated to assess the prognostic value of FDG PET and clinical follow-up was taken as gold standard. Results: PET was positive in nineteen of 41 patients studied for treatment reevaluation. Progression was observed after a median interval of two months (range 0-15) in sixteen of 19 patients after a positive PET scan and in three of 22 patients after a negative scan (p <.001). Median duration of follow-up in progression-free patients was 21 months (range 6-72). In patients with a partial remission in CRS progression was more common in PET-positive than in PET-negative patients (5 of 7 vs. 1 of 14; ñ <.01) and positivity with PET was associated with poorer PFS (p <.0025). PET studies performed four to twelve months after treatment were true negative in seven, true positive in five and false-positive in three patients. SUV > 11.35 of lymphoma lesions was associated with poorer PFS than SUV <11.35 (p <0.025). Conclusion: We conclude that FDG PET after treatment of malignant lymphoma has a high prognostic value and should be recommended in patients with persistence of residual masses.

Zusammenfassung

Ziel: Untersuchung der prognostischen Bedeutung der Positronen-Emissions-Tomographie (PET) mit F-l 8-Fluor-deoxyglukose im Vergleich zu konventionellen Restaging-verfahren (CRS) bei Patienten, welche wegen eines Morbus Hodgkin (HD) oder eines Non-Hodgkin-Lymphoms (NHL) behandelt wurden. Methoden: 56 Patienten wurden eingeschlossen, hierunter 22 mit HD, 26 mit NHL und acht mit einem zentrozytisch-zentroblastischen NHL. Die PET wurde bei 41 Patienten als Therapiekontrolle innerhalb von drei Monaten nach Therapieende durchgeführt. 10 Patienten wurden wegen persistierender residualer Raumforderungen und fünf wegen eines Rezidivverdachtes vier bis zwölf Monate nach Therapieende untersucht. Die PET-Untersuchungen wurden qualitativ und quantitativ mittels des ^standardised uptake value« (SUV) befandet. Das progressionsfreie Überleben (PFS) wurde als klinischer Endpunkt erhoben und der klinische Verlauf als Goldstandard betrachtet. Ergebnisse: 19 von 41 Patienten, welche zur Therapiekontrolle untersucht wurden, wiesen pathologische PET-Befunde auf. Bei 16 von 19 Patienten wurde nach einer positiven PET ein Lymphomprogress beobachtet, dagegen nur bei drei von 22 Patienten nach einer negativen PET (p <0,001). Die mediane Zeitdauer bis zum Auftreten eines Progresses betrug zwei Monate (Spannweite 0-15 Monate), die mediane Beobachtungsdauer bei progressionsfreiem Verlauf 21 Monate (Spannweite 6-72 Monate). Bei Patienten mit einer partiellen Remission in der konventionellen Diagnostik war ein Progress ebenfalls signifikant häufiger nach einer positiven PET (5 von 7 versus 1 von 14 Fällen; ñ <0,01). Die zwischen vier und zwölf Monate nach Therapie durchgeführten PET-Studien waren richtig negativ bei sieben, richtig positiv bei fünf und falsch positiv bei drei Patienten. Ein SUV >11,35 des Restlymphoms war mit einem signifikant kürzeren PFS (ñ <0,025) assoziiert. Sihlussfolgerung: Wir schließen hieraus, dass die FDG-PET bei Patienten, welche wegen eines malignen Lymphoms therapiert wurden, eine hohe prognostische Bedeutung besitzt und insbesondere bei der Persistenz von Residualbefunden empfohlen werden sollte.

Keywords

PET - FDG - malignant lymphoma - prognosis - residual mass

Schlüsselwörter

PET - FDG - malignes Lymphom - Prognose - residuale Raumforderung

Full Text

References

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