Recommendations to stage and assess the response to therapy of lymphomas with [¹⁸F]FDG-PET-CT - 22/02/16

Doi : 10.1016/j.mednuc.2015.12.004

S.F. Barrington ^a,^⁎ , P. Fosse ^b, N. Withofs ^c, E. Itti ^d, R. Hustinx ^c, O.-F. Couturier ^b, M. Meignan ^d
^a PET Imaging Centre at St Thomas, Lambeth Palace Road, London SE1 7EH, UK
^b Department of Nuclear Medicine, University of Angers, 49033 Angers, France
^c Department of Nuclear Medicine, University of Liege, Liege, Belgium
^d Department of Nuclear Medicine, Henri-Mondor University Hospitals, 94010 Créteil, France

^⁎Corresponding author.

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Abstract

Mounting evidence supports the major role of [¹⁸F]FDG PET-CT in the assessment of response to chemotherapy in lymphoma. The five-point scale to grade response is becoming widely used both in practice and response-adapted trials. In 2014, a malignant lymphomas imaging working group composed of representatives from major international cooperative groups published revised guidelines concerning the role of imaging in the staging and response assessment of lymphoma. This paper summarizes the main recommendations to facilitate their clinical routine applications.

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Résumé

Une accumulation de preuves soutient le rôle majeur de la [¹⁸F]FDG TEP/TDM dans l’évaluation de la réponse à la chimiothérapie dans le lymphome. L’échelle à cinq points de réponse est de plus en plus largement utilisée à la fois dans les essais cliniques qu’en pratique clinique. En 2014, un groupe de travail sur l’imagerie des lymphomes malins, composé de représentants des principaux groupes de coopération internationale, a publié des directives révisées sur le rôle de l’imagerie dans le bilan d’extension et dans l’évaluation de la réponse des lymphomes. Ce document résume les principales recommandations pour faciliter leurs applications en routine clinique.

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Keywords : Lymphoma, FDG, Positron emission tomography, Staging, Response to treatment

Mots clés : Lymphome, FDG, Tomographie par émission de positons, Bilan d’extension, Réponse aux traitements

Plan

Introduction

Staging

Recommendation 1: [¹⁸F]FDG PET-CT should be used for staging in routine clinical practice and in clinical trials

Recommendation 2: [¹⁸F]FDG scans can be used to image most subtypes of lymphomas and to target biopsy

Recommendation 3: in HL staged by PET-CT, there is no role for routine bone marrow biopsy (BMB).

Recommendation 4: in DLBCL, BMB maybe indicated if there is no abnormal marrow uptake on the PET scan, but only if it would change prognosis or therapy

Response assessment - visual

Recommendation 5: the Deauville criteria are recommended for reporting [¹⁸F]FDG-PET-CT scans at both interim and end treatment assessment

Recommendation 6: if mid-treatment imaging is performed, [¹⁸F]FDG PET-CT is recommended as the most accurate method for early response assessment

Recommendation 7: there is currently insufficient evidence to change standard treatment based solely on interim [¹⁸F]FDG PET-CT. The [¹⁸F]FDG PET-CT result should be used in the same way as mid-treatment CT is currently used. Imaging findings should be related to the anticipated prognosis, clinical findings and other markers of response

Response assessment–quantitative

Recommendation 8: standardisation of [¹⁸F]FDG PET-CT methods is mandatory for the use of quantitative approaches

Recommendation 9: published data support the utility of ΔSUV_max in response assessment in DLBCL and HL but the predictive value of metabolic tumour volumes should also be explored

Conclusion

Disclosure of interest

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Vol 40 - N° 1

P. 55-64 - février 2016 Retour au numéro

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Recommendations to stage and assess the response to therapy of lymphomas with [¹⁸F]FDG-PET-CT - 22/02/16

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