Article (Scientific journals)
Evaluation of therapy for lymphoma.
Jerusalem, Guy; Hustinx, Roland; Beguin, Yves et al.
2005In Seminars in Nuclear Medicine, 35 (3), p. 186-96
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Keywords :
Antineoplastic Agents/therapeutic use; Clinical Trials as Topic; Fluorodeoxyglucose F18/diagnostic use; Humans; Lymphoma/radionuclide imaging/therapy; Physician's Practice Patterns; Positron-Emission Tomography/methods; Practice Guidelines as Topic; Prognosis; Radioimmunotherapy/methods; Radiopharmaceuticals/diagnostic use; Treatment Outcome
Abstract :
[en] 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%.
Disciplines :
Hematology
Author, co-author :
Jerusalem, Guy  ;  Centre Hospitalier Universitaire de Liège - CHU > Oncologie médicale
Hustinx, Roland  ;  Centre Hospitalier Universitaire de Liège - CHU > Médecine nucléaire
Beguin, Yves  ;  Centre Hospitalier Universitaire de Liège - CHU > Hématologie clinique
Fillet, Georges ;  Centre Hospitalier Universitaire de Liège - CHU > Hématologie clinique
Language :
English
Title :
Evaluation of therapy for lymphoma.
Publication date :
2005
Journal title :
Seminars in Nuclear Medicine
ISSN :
0001-2998
eISSN :
1558-4623
Publisher :
W.B. Saunders, Philadelphia, United States - Pennsylvania
Volume :
35
Issue :
3
Pages :
186-96
Peer reviewed :
Peer Reviewed verified by ORBi
Available on ORBi :
since 25 February 2009

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