The place of positron emission tomography imaging in the management of patients with malignant lymphoma.
Jerusalem, Guy ; Beguin, Yves
in Haematologica (2006), 91(4), 442-4Detailed reference viewed: 11 (4 ULg)
Sequential positron emission tomography using [18F]fluorodeoxyglucose for monitoring response to chemotherapy in metastatic breast cancer.
; Jerusalem, Guy ; et al
in Clinical Cancer Research : An Official Journal of the American Association for Cancer Research (2006), 12(21), 6437-43
PURPOSE: To evaluate the clinical value of positron emission tomography (PET) for monitoring chemotherapy in metastatic breast cancer. EXPERIMENTAL DESIGN: Twenty patients with hormonorefractory or ... [more ▼]
PURPOSE: To evaluate the clinical value of positron emission tomography (PET) for monitoring chemotherapy in metastatic breast cancer. EXPERIMENTAL DESIGN: Twenty patients with hormonorefractory or hormonoreceptor-negative multimetastatic breast cancer were prospectively included. PET studies were done at baseline, at day 21 after the first cycle and at day 21 after the third cycle of chemotherapy. Metabolic response was defined based on visual and various modes of standardized uptake value (SUV) analysis of sequential PET studies. RESULTS: After one cycle, PET indicated a partial response in 12 patients, stable disease in 7 patients, and progressive disease in 1 patient, according to the visual analysis. After three cycles, PET showed a complete response in 5 patients, partial response in 11 patients, stable disease in 3 patients, and progressive disease in 1 patient. Seventy-five percent of the patients showing a metabolic response on visual analysis effectively responded to the treatment. The average SUV decreased on both the second and the third PET study, but only changes measured after three cycles of chemotherapy predicted the clinical response to chemotherapy and the overall survival. All methods for calculating the SUV (normalized for body weight, body surface area, or lean body mass) provided similar results. CONCLUSION: Semiquantitative analysis of [18F]fluorodeoxyglucose-PET studies done after three cycles of chemotherapy is useful for monitoring the response to chemotherapy in metastatic breast cancer. [less ▲]Detailed reference viewed: 28 (8 ULg)
F-18-FDG PET in children with lymphomas
Depas, Gisèle ; ; Jerusalem, Guy et al
in European Journal of Nuclear Medicine and Molecular Imaging (2005), 32(1), 31-38
Purpose: The aim of this study was to retrospectively evaluate the performance of positron emission tomography (PET) with F-18-fluorodeoxyglucose (F-18-FDG) in children with lymphomas, at various stages ... [more ▼]
Purpose: The aim of this study was to retrospectively evaluate the performance of positron emission tomography (PET) with F-18-fluorodeoxyglucose (F-18-FDG) in children with lymphomas, at various stages of their disease. Methods: Twenty-eight children (mean age 12.5 years, 14 girls, 14 boys) with Hodgkin's disease (HD, n=17) or non-Hodgkin's lymphoma (NHL, n= 11) were evaluated. Patients were investigated at initial staging (n=19), early in the course of treatment (n=19), at the end of treatment (n=16) and during long-term follow-up (n=19). A total of 113 whole-body PET studies were performed on dedicated scanners. PET results were compared with the results of conventional methods (CMs) such as physical examination, laboratory studies, chest X-rays, computed tomography, magnetic resonance imaging, ultrasonography and bone scan when available. Results: At initial evaluation (group 1), PET changed the disease stage and treatment in 10.5% of the cases. In early evaluation of the response to treatment (group 2), PET failed to predict two relapses and one incomplete response to treatment. In this group, however, PET did not show any false positive results. There were only 4/75 false positive results for PET among patients studied at the end of treatment (group 3, specificity 94%) or during the systematic follow-up (group 4, specificity 95%), as compared with 27/75 for CMs (specificity 54% and 66%, respectively). Conclusion: F-18-FDG-PET is a useful tool for evaluating children with lymphomas. Large prospective studies are needed to appreciate its real impact on patient management. [less ▲]Detailed reference viewed: 46 (5 ULg)
Evaluation of therapy for lymphoma.
Jerusalem, Guy ; Hustinx, Roland ; Beguin, Yves et al
in Seminars in Nuclear Medicine (2005), 35(3), 186-96
Positron emission tomography (PET) using (18)F-fluorodeoxyglucose ((18)F-FDG) is the best noninvasive imaging technique for to assess response in patients suffering from lymphoma. Early response ... [more ▼]
Positron emission tomography (PET) using (18)F-fluorodeoxyglucose ((18)F-FDG) is the best noninvasive imaging technique for to assess response in patients suffering from lymphoma. Early response evaluation ("interim PET") after one, a few cycles, or at midtreatment can predict response, progression-free survival, and overall survival. We calculated from data of 7 studies an overall sensitivity to predict treatment failure of 79%, a specificity of 92%, a positive predictive value (PPV) of 90%, a negative predictive value (NPV) of 81%, and an accuracy of 85%. Although it is not yet indicated to change patient management based on residual (18)F-FDG uptake on interim scan in chemotherapy-sensitive patients, prospective studies evaluating the role of an interim PET in patient management clearly are warranted. (18)F-FDG PET also has an important prognostic role in relapsing patients after reinduction chemotherapy before high-dose chemotherapy (HCT) followed by autologous stem cell transplantation (ASCT). However, all chemotherapy-sensitive patients remain candidates for HCT followed by ASCT, even if (18)F-FDG PET showed residual (18)F-FDG uptake. We calculated from data of 3 studies an overestimated risk of relapse in 16% of all PET-positive patients. Some patients with residual (18)F-FDG uptake will have a good outcome after HCT followed by ASCT. (18)F-FDG PET is the imaging technique of choice for end-of-treatment evaluation. However, (18)F-FDG is not specific for tumoral tissue. Active inflammatory lesions and infectious processes can be falsely interpreted as malignant residual cells. However, a negative (18)F-FDG PET cannot exclude minimal residual disease. Consequently, it is always indicated to correlate PET findings with clinical data, other imaging modalities, and/or a biopsy. We calculated, from data of 17 studies in end-of-treatment evaluation, a sensitivity of 76%, a specificity of 94%, a PPV of 82%, a NPV 92%, and an accuracy of 89%. [less ▲]Detailed reference viewed: 31 (6 ULg)
Positron emission tomography imaging for lymphoma.
Jerusalem, Guy ; Hustinx, Roland ; Beguin, Yves et al
in Current Opinion in Oncology (2005), 17(5), 441-5
PURPOSE OF REVIEW: To review the current role and the limitations of F-fluorodeoxygenase positron emission tomography in the management of lymphoma, with a particular focus on studies published since ... [more ▼]
PURPOSE OF REVIEW: To review the current role and the limitations of F-fluorodeoxygenase positron emission tomography in the management of lymphoma, with a particular focus on studies published since January 2004. RECENT FINDINGS: F-fluorodeoxygenase positron emission tomography should be routinely performed at the initial diagnosis of patients with suffering from Hodgkin's disease because it adds useful informations to conventional staging techniques. Residual F-fluorodeoxygenase uptake is an important prognostic factor after one or a few cycles of chemotherapy, but it is clearly too early to change patient treatment on the basis of F-fluorodeoxygenase positron emission tomography results. F-fluorodeoxygenase positron emission tomography is the best noninvasive imaging technique after treatment; however, it is always indicated to correlate positron emission tomography findings with clinical data, other imaging modalities, a biopsy, or all three to reduce the risk of false positive results. There are some concerns about the positive predictive value of positron emission tomography after treatment, especially in childhood lymphoma. Clinicians should be aware of positron emission tomography findings in specific clinical conditions in this patient population. F-fluorodeoxygenase positron emission tomography combined with computed tomography offers advantages over the two used separately and read side by side. It may be particularly useful for the planning of radiation therapy or for the planning of a surgical biopsy. Several studies have shown that F-fluorodeoxygenase positron emission tomography is definitively superior to Ga scintigraphy. New radiotracers such as F-fluorothymidine may be useful for the noninvasive assessment of proliferation in vivo. SUMMARY: F-fluorodeoxygenase positron emission tomography has become the most important nuclear medicine imaging modality in the field of lymphoma. It should be routinely used in the treatment of lymphoma patients. [less ▲]Detailed reference viewed: 25 (4 ULg)
Whole-Body Positron Emission Tomography using 18F-Fluorodeoxyglucose for Staging Response Assessment in Hodgkin's Disease
Jerusalem, Guy ; Hustinx, Roland ; Beguin, Yves et al
in Heinz, Beverley C. (Ed.) Trends in Hodgkin's Disease Research (2005)
Hodgkin's disease, sometimes called Hodgkin's lymphoma, is a cancer that starts in lymphatic tissue. Lymphatic tissue includes the lymph nodes and related organs that are part of the body's immune and ... [more ▼]
Hodgkin's disease, sometimes called Hodgkin's lymphoma, is a cancer that starts in lymphatic tissue. Lymphatic tissue includes the lymph nodes and related organs that are part of the body's immune and blood-forming systems. The lymph nodes are small, bean-shaped organs found underneath the skin in the neck, underarm, and groin. They are also found in many other places in the body such as inside the chest, abdomen, and pelvis. Lymph nodes make and store infection-fighting white blood cells, called lymphocytes. They are connected throughout the body by lymph vessels (narrow tubes similar to blood vessels). These lymph vessels carry a colourless, watery fluid (lymphatic fluid) that contains lymphocytes. Eventually the lymphatic fluid is emptied into the blood vessels in the left upper chest. There are 5 different types of Hodgkin's lymphoma: Nodular sclerosing Hodgkin's lymphoma; Mixed cellularity Hodgkin's lymphoma; Lymphocyte depletion Hodgkin's lymphoma; Lymphocyte-rich classical Hodgkin's lymphoma; Nodular lymphocyte-predominant Hodgkin's lymphoma. This volume examines and presents leading-edge research in this field. Preface; What Causes Hodgkin’s Disease? A Review of Analytical Epidemiology; Progress in Hodgkin’s Disease Research; New Insights in Pediatric Hodgkin’s Disease; Hodgkin’s Lymphoma and Infection; Roles of CD30 Signal Transduction in the Biology of Classic Hodgkin’s Lymphoma; Whole-Body Positron Emission Tomography Using 18F-Fluorodeoxyglucose for Staging and Response Assessment in Hodgkin’s Disease; The Clinical Value of Nuclear Medicine in the Assessment of Radio-and Chemotherapy Related Pulmonary and Cardiac Normal Tissue Damage in Patients with Hodgkin’s Disease; Cell Fusion and Carcinogenesis. Hodgkin and Reed-Sternberg Cells as Paradigm of Cell Fusion and Cell Cancerisation; Existential and Psychosocial Issues for Hodgkin’s Disease Survivors; Index. [less ▲]Detailed reference viewed: 19 (2 ULg)
Metabolic monitoring of chemosensitivity with 18FDG PET.
Jerusalem, Guy ;
in Methods in Molecular Medicine (2005), 111
Accurate and early evaluation of tumor response to chemotherapy is a growing clinical need for optimal management of oncology patients. This is even more warranted by the lack of appropriate response ... [more ▼]
Accurate and early evaluation of tumor response to chemotherapy is a growing clinical need for optimal management of oncology patients. This is even more warranted by the lack of appropriate response evaluation criteria to new molecularly targeted anticancer therapies. In the two last decades, new developments in the field of nuclear oncology have allowed the introduction of various radiopharmaceuticals to be used on dedicated imaging devices. In the present chapter, we report the added value that positron emission tomography (PET) with 18F-fluorodeoxyglucose (18FDG) may offer to assess tumor response to treatment. PET is a high-end imaging technology using 18FDG as metabolic tracer that mimics the biochemical behavior of the natural glucose molecule. Because most tumor types exhibit increased glucose metabolism, the imaging of 18FDG uptake within cancer tissues prior to any treatment enables the metabolic technique to follow tumor responsiveness sequentially after one or several courses of chemotherapy. Moreover, metabolic tumor response evaluated by 18FDG PET often precedes morphological tumor changes measured by computed tomography or magnetic resonance imaging. So far, the suboptimal proper ties of 18FDG tracer and the lack of standardized methodology in PET imaging remain objective limitations for qualitative and quantitative assessment of chemosensitivity using the metabolic method. [less ▲]Detailed reference viewed: 15 (2 ULg)
Sequential administration of epirubicin and paclitaxel for advanced breast cancer. A phase I randomised trial.
; ; et al
in Anticancer Research (2005), 25(2B), 1211-7
Forty-six previously untreated patients with advanced breast cancer were eligible for the present randomised phase I study. It aimed to evaluate the toxicity and activity of a therapeutic sequence with ... [more ▼]
Forty-six previously untreated patients with advanced breast cancer were eligible for the present randomised phase I study. It aimed to evaluate the toxicity and activity of a therapeutic sequence with epirubicin on day 1 followed by paclitaxel on day 2 (sequence A) or the reverse sequence, ie., paclitaxel on day 1 followed by epirubicin on day 2 (sequence B). The starting doses of epirubicin and paclitaxel, administered either according to sequence A or B, (level 1 cohort) were 90 mg/m2 and 175 mg/m2, respectively. Per cohort of 3 patients, the dose of paclitaxel was increased by 25 mg/m2 (levels 2 and 4) and of epirubicin by 10 mg/m2 (levels 3 and 5). Treatment was repeated with 3-week intervals. The maximal tolerated dose (MTD) was achieved at level 1 in sequence B (paclitaxel first) and level 3 (epirubicin 100 mg/m2 followed by paclitaxel 200 mg m2) in sequence A. Dose limiting toxicity (DLT) was neutropenia (+/- febrile) in both sequences. Cardiac events occurred in 28% of the patients; significant decrease in left ventricular ejection function (LVEF) was observed in 8/33 and in 2/13 patients in sequence A and B, respectively. This was associated with 5 and 1 cardiac heart failure (CHF), respectively. In 43 evaluable patients, 10 CR and 25 PR were observed (overall response rate 81%). In the 20 patients with locally advanced disease (LABC), the respective numbers were 7 CR and 11 PR; in the 23 metastatic (MBC) patients, 3 CR and 14 PR were recorded. The median survival of the both groups was not reached at 33 + months. In conclusion , the combination of epirubicin and paclitaxel has significant activity in breast cancer. The recommended sequence of both drugs in combination therapy, mainly to avoid neutropenia, is epirubicin day 1 followed by paclitaxel on day 2. Cardiac toxicity remains problematic in either sequence of administration. [less ▲]Detailed reference viewed: 28 (2 ULg)
L'image du mois. Tumeur de Merkel : reponse majeure a la chimiotherapie. "Il n'y a pas que la neige qui fond au soleil"...
Polus, Marc ; Piront, Patricia ; Jerusalem, Guy et al
in Revue Médicale de Liège (2004), 59(2), 67-8Detailed reference viewed: 411 (6 ULg)
Traitement du cancer du sein chez la personne âgée
Gillain, Sophie ; Gennigens, Christine ; Sautois, Brieuc et al
in Revue Médicale Suisse (2004), 62
Le cancer du sein représente chez la personne âgée une pathologie fréquente. Le choix du traitement dépend de l'âge physiologique, des pathologies et comorbidités associées ainsi que du niveau de vie et d ... [more ▼]
Le cancer du sein représente chez la personne âgée une pathologie fréquente. Le choix du traitement dépend de l'âge physiologique, des pathologies et comorbidités associées ainsi que du niveau de vie et d'autonomie. De plus, selon les facteurs histopronostiques (récepteurs aux oestrogènes et à la progestérone, la surexpression du cerb-B2) on décidera éventuellement du schéma thérapeutique le plus approprié. Chez la personne âgée, la chirurgie (mastectomie ou tumorectomie), la radiothérapie et l'hormonothérapie trouvent leur place. Au-delà de 70 ans, la place de la chimiothérapie est incertaine. En effet, les patientes de plus de 70 ans sont sous-représentées dans les études randomisées. [less ▲]Detailed reference viewed: 245 (5 ULg)
CD34+ cell dose predicts costs after autologous peripheral blood stem cell transplantation for breast cancer.
Baron, Frédéric ; ; Baudoux, Etienne et al
in Haematologica (2004), 89(9), 1146-8
We assessed the effect of CD34+ cell dose on costs in breast cancer patients undergoing autologous peripheral blood stem cell (PBSC) transplantation. Mean hospitalization costs were 26,992.9+/-9582.9 for ... [more ▼]
We assessed the effect of CD34+ cell dose on costs in breast cancer patients undergoing autologous peripheral blood stem cell (PBSC) transplantation. Mean hospitalization costs were 26,992.9+/-9582.9 for patients receiving a CD34+ cell dose <5 x 10(6) cells/kg versus 22,339.4+/- 5471.1 for those receiving >5 x 10(6) CD34+ cells/kg (p=0.0065). [less ▲]Detailed reference viewed: 30 (7 ULg)
Tomographie a emission de positons: une revolution en cancerologie?
Jerusalem, Guy ; Hustinx, Roland
in Revue du Praticien (La) (2003), 53(15), 1629-30Detailed reference viewed: 7 (2 ULg)
Whole-body tumor imaging using PET and 2-18F-fluoro-l-tyrosine: Preliminary evaluation and comparison with 18F-FDG
Hustinx, Roland ; Lemaire, Christian ; Jerusalem, Guy et al
in Journal of Nuclear Medicine : Official Publication, Society of Nuclear Medicine (2003), 44(4), 533-539
18F-FDG PET imaging is now established as a valuable tool for evaluating cancer patients. However, a limitation of 18F-FDG is its absence of specificity for tumor. Both protein synthesis and amino acid ... [more ▼]
18F-FDG PET imaging is now established as a valuable tool for evaluating cancer patients. However, a limitation of 18F-FDG is its absence of specificity for tumor. Both protein synthesis and amino acid transport are enhanced in most tumor cells, but their metabolism is less affected in inflammation. We therefore decided to evaluate the ability of PET with 2-18F-fluoro-L-tyrosine (18F-TYR) to visualize cancer lesions in patients compared with 18F-FDG PET. Methods: 18F-FDG PET and 18F-TYR PET were performed on 23 patients with histologically proven malignancies (11 non-small cell lung cancers (NSCLCs), 10 lymphomas, and 2 head and neck carcinomas). Fully corrected, whole-body PET studies were obtained on separate days. 18F-FDG studies were performed after routine clinical fashion. 18F-TYR studies were started 36 ± 6 min after tracer injection and a second scan centered over a reference lesion was acquired after completion of the whole-body survey-on average, 87 min after injection. Standardized uptake values (SUVs) were calculated for all abnormal foci and for various normal structures. Results were compared with pathologic or correlative studies. Results: 18F-FDG PET correctly identified 54 malignant lesions, among which 36 were also visualized with 18F-TYR (67%). 18F-TYR did not detect any additional lesion. Tumor SUVs (SUVbw, 5.2 vs. 2.5), tumor-to-muscle (7.4 vs. 2.7), and tumor-to-mediastinum activity ratios (3 vs. 1.4) were higher with 18F-FDG than with 18F-TYR. Two of 11 NSCLCs and 4 of 10 lymphomas were understaged with 18F-TYR compared with 18F-FDG. Although the NSCLC lesions missed by 18F-TYR PET were small, several large lymphoma lesions did not accumulate the tracer. In 4 patients, 18F-TYR-positive lesions coexisted with 18F-TYR-negative lesions. There was a high physiologic 18F-TYR uptake by the pancreas (average SUVbw, 10.3) and the liver (average SUVbw, 6.3). Muscle and bone marrow uptakes were also higher with 18F-TYR than with 18F-FDG: average SUVbw, 1 versus 0.7 and 2.6 versus 1.8, respectively. There was no change over time in the 18F-TYR uptake by the tumors or the normal structures. Conclusion: 18F-TYR PET is not superior to 18F-FDG PET for staging patients with NSCLC and lymphomas. [less ▲]Detailed reference viewed: 95 (5 ULg)
Prevention primaire et secondaire du cancer colorectal
Polus, Marc ; Piront, Patricia ; Jerusalem, Guy et al
in Revue Médicale de Liège (2003), 58(4), 247-53
Colorectal cancer is really a public health problem. The authors review the literature about the environmental factors leading to colorectal cancer. Chemoprevention of colorectal cancer is also discussed ... [more ▼]
Colorectal cancer is really a public health problem. The authors review the literature about the environmental factors leading to colorectal cancer. Chemoprevention of colorectal cancer is also discussed, particularly by aspirin and non steroidal anti-inflammatory drugs. Development of specific cyclooxygenase-2 inhibitors constitutes a promising research's field. Secondary prevention by coloscopy and polypectomy must lead to a lower rate of colorectal cancer disease and improvement of mortality. [less ▲]Detailed reference viewed: 122 (2 ULg)
Whole-body FDG PET imaging as a method for staging and early assessment of treatment response in pediatric patients with lymphoma.
; ; et al
in Journal of Nuclear Medicine (The) (2003), 44Detailed reference viewed: 10 (1 ULg)
Whole-body FDG PET in the follow-up of pediatric patients with lymphoma.
; ; et al
in Journal of Nuclear Medicine (The) (2003), 44Detailed reference viewed: 9 (1 ULg)
Radiothérapie métabolique des douleurs osseuses métastatiques
Hustinx, Roland ; Sautois, Brieuc ; Jerusalem, Guy et al
in Médecine et Hygiène (2003), 61
La radiothérapie métabolique des métastases osseuses est un traitement palliatif de la douleur. Cet objectif est rempli dans la grande majorité des cas, sans effets secondaires cliniquement ressentis par ... [more ▼]
La radiothérapie métabolique des métastases osseuses est un traitement palliatif de la douleur. Cet objectif est rempli dans la grande majorité des cas, sans effets secondaires cliniquement ressentis par le patient. Tous les patients en dissémination osseuse ne peuvent cependant bénéficier de cette approche qui, lorsqu'elle est choisie, doit toujours être appliquée dans un cadre multidisciplinaire. Les lésions accessibles à ce traitement doivent avoir démontré leur caractère ostéocondensant en scintigraphie. La fonction rénale et la réserve médullaire sont des paramètres importants, l'élimination des radiopharmaceutiques étant urinaire et leur toxicité, médullaire. Les situations particulières telles que risque fracturaire important ou compression médullaire sont des contre-indications. Le traitement est simple dans son principe et dans sa réalisation. Il permet une amélioration très significative de la qualité de vie, tout en réalisant des économies substantielles en terme de coût de santé publique. [less ▲]Detailed reference viewed: 74 (1 ULg)
Phase III randomized study comparing 5 or 10 microg per kg per day of filgrastim for mobilization of peripheral blood progenitor cells with chemotherapy, followed by intensification and autologous transplantation in patients with nonmyeloid malignancies.
; Baudoux, Etienne ; et al
in Transfusion (2003), 43(1), 50-7
BACKGROUND: It is not known whether increasing the dose of filgrastim after mobilizing chemotherapy improves collection of peripheral blood progenitor cells (PBPC) and leads to faster hematopoietic ... [more ▼]
BACKGROUND: It is not known whether increasing the dose of filgrastim after mobilizing chemotherapy improves collection of peripheral blood progenitor cells (PBPC) and leads to faster hematopoietic engraftment after autologous transplantation. STUDY DESIGN AND METHODS: A randomized, open-label, multicenter trial was carried out in patients with breast cancer, multiple myeloma, and lymphoma, in which patients were randomized to receive 5 or 10 microg per kg per day of filgrastim after standard chemotherapy to mobilize PBPCs. After high-dose chemotherapy, the components from the first two leukapheresis procedures were returned, and all patients received 5 microg per kg day of filgrastim after transplantation. RESULTS: A total of 131 patients were randomized, of whom 128 were mobilized (Group A, 5 microg/kg, n = 66; Group B, 10 microg/kg, n = 62) and 112 were transplanted. Only six patients were not transplanted because of insufficient CD34+ cell numbers. The median number of CD34+ cells collected in the first two leukapheresis procedures tended to be higher in Group B than in Group A (12.0 vs. 7.2 x 10(6)/kg, NS), but after transplantation there was no significant difference in median times to platelet (9 days in both groups) or neutrophil (8 days in both groups) engraftment or the number of platelet transfusions (three in both groups). A subsequent subgroup analysis separating patients transplanted after first- or second-line chemotherapy also showed no measurable impact of filgrastim dose on the median CD34+ cell yield or on platelet engraftment in either subgroup. CONCLUSION: PBPC mobilization with chemotherapy and 5 microg per kg of filgrastim is very efficient, and 10 microg per kg of filgrastim does not provide additional clinical benefit. [less ▲]Detailed reference viewed: 135 (6 ULg)