Journal article
Positron Emission Tomography/Computed Tomography Assessment After Immunochemotherapy and Irradiation Using the Lugano Classification Criteria in the IELSG-26 Study of Primary Mediastinal B-Cell Lymphoma.
- Ceriani L Nuclear Medicine and PET-CT Center, Oncology Institute of Southern Switzerland, Bellinzona, Switzerland. Electronic address: luca.ceriani@eoc.ch.
- Martelli M Department of Cellular Biotechnologies and Hematology, Sapienza University, Rome, Italy.
- Gospodarowicz MK Radiation Oncology, University of Toronto, Toronto, Ontario, Canada.
- Ricardi U Department of Oncology, University of Torino, Torino, Italy.
- Ferreri AJ Unit of Lymphoid Malignancies, Department of Onco-Hematology, Istituto Di Ricovero e Cura a Carattere Scientifico (IRCCS) San Raffaele Scientific Institute, Milano, Italy.
- Chiappella A Hematology, Azienda Ospedaliera Universitaria Città della Salute e della Scienza, Torino, Italy.
- Stelitano C Hematology, Azienda Ospedaliera Bianchi-Melacrino-Morelli, Reggio Calabria, Italy.
- Balzarotti M Hematology, IRCCS Humanitas Cancer Center, Rozzano, Milan, Italy.
- Cabrera ME Hematology, Hospital del Salvador, Universidad de Chile, Santiago, Chile.
- Cunningham D Department of Medicine, The Royal Marsden National Health Service Foundation Trust, London and Surrey, United Kingdom.
- Guarini A Hematology Unit, Istituto Nazionale Tumori Giovanni Paolo II IRCCS, Bari, Italy.
- Zinzani PL Institute of Hematology and Medical Oncology, Policlinico S.Orsola-Malpighi, Bologna, Italy.
- Giovanella L Nuclear Medicine and PET-CT Center, Oncology Institute of Southern Switzerland, Bellinzona, Switzerland.
- Johnson PW Cancer Research UK Centre, University of Southampton, Southampton, United Kingdom.
- Zucca E Oncology Department, Oncology Institute of Southern Switzerland, Bellinzona, Switzerland.
- 2016-11-15
Published in:
- International journal of radiation oncology, biology, physics. - 2017
Adult
Antineoplastic Combined Chemotherapy Protocols
Bleomycin
Cyclophosphamide
Disease Progression
Disease-Free Survival
Doxorubicin
Etoposide
Female
Fluorodeoxyglucose F18
Humans
Immunotherapy
Leucovorin
Liver
Lymphoma, B-Cell
Male
Mediastinal Neoplasms
Methotrexate
Neoplasm, Residual
Positron Emission Tomography Computed Tomography
Prednisone
Prospective Studies
Radiopharmaceuticals
Radiotherapy Dosage
Radiotherapy, Conformal
Recurrence
Rituximab
Statistics, Nonparametric
Vincristine
Young Adult
English
PURPOSE
To assess the predictive value of 18F-fluorodeoxyglucose positron emission tomography/computed tomography (PET/CT) for disease recurrence after immunochemotherapy (R-CHT) and mediastinal irradiation (RT), using the recently published criteria of the Lugano classification to predict outcomes for patients with primary mediastinal large B-cell lymphoma.
METHODS AND MATERIALS
Among 125 patients prospectively enrolled in the IELSG-26 study, 88 were eligible for central review of PET/CT scans after completion of RT. Responses were evaluated using the 5-point Deauville scale at the end of induction R-CHT and after consolidation RT. According to the Lugano classification, a complete metabolic response (CMR) was defined by a Deauville score (DS) ≤3.
RESULTS
The CMR (DS1, -2, or -3) rate increased from 74% (65 patients) after R-CHT to 89% (78 patients) after consolidation RT. Among the 10 patients (11%) with persistently positive scans, the residual uptake after RT was slightly higher than the liver uptake in 6 patients (DS4; 7%) and markedly higher in 4 patients (DS5; 4%): these patients had a significantly poorer 5-year progression-free survival and overall survival. At a median follow-up of 60 months (range, 35-107 months), no patients with a CMR after RT have relapsed. Among the 10 patients who did not reach a CMR, 3 of the 4 patients (positive predictive value, 75%) with DS5 after RT had subsequent disease progression (within the RT volume in all cases) and died. All patients with DS4 had good outcomes without recurrence.
CONCLUSIONS
All the patients obtaining a CMR defined as DS ≤3 remained progression-free at 5 years, confirming the excellent negative predictive value of the Lugano classification criteria in primary mediastinal large B-cell lymphoma patients. The few patients with DS4 also had an excellent outcome, suggesting that they do not necessarily require additional therapy, because the residual 18F-fluorodeoxyglucose uptake may not reflect persistent lymphoma.
To assess the predictive value of 18F-fluorodeoxyglucose positron emission tomography/computed tomography (PET/CT) for disease recurrence after immunochemotherapy (R-CHT) and mediastinal irradiation (RT), using the recently published criteria of the Lugano classification to predict outcomes for patients with primary mediastinal large B-cell lymphoma.
METHODS AND MATERIALS
Among 125 patients prospectively enrolled in the IELSG-26 study, 88 were eligible for central review of PET/CT scans after completion of RT. Responses were evaluated using the 5-point Deauville scale at the end of induction R-CHT and after consolidation RT. According to the Lugano classification, a complete metabolic response (CMR) was defined by a Deauville score (DS) ≤3.
RESULTS
The CMR (DS1, -2, or -3) rate increased from 74% (65 patients) after R-CHT to 89% (78 patients) after consolidation RT. Among the 10 patients (11%) with persistently positive scans, the residual uptake after RT was slightly higher than the liver uptake in 6 patients (DS4; 7%) and markedly higher in 4 patients (DS5; 4%): these patients had a significantly poorer 5-year progression-free survival and overall survival. At a median follow-up of 60 months (range, 35-107 months), no patients with a CMR after RT have relapsed. Among the 10 patients who did not reach a CMR, 3 of the 4 patients (positive predictive value, 75%) with DS5 after RT had subsequent disease progression (within the RT volume in all cases) and died. All patients with DS4 had good outcomes without recurrence.
CONCLUSIONS
All the patients obtaining a CMR defined as DS ≤3 remained progression-free at 5 years, confirming the excellent negative predictive value of the Lugano classification criteria in primary mediastinal large B-cell lymphoma patients. The few patients with DS4 also had an excellent outcome, suggesting that they do not necessarily require additional therapy, because the residual 18F-fluorodeoxyglucose uptake may not reflect persistent lymphoma.
- Language
-
- English
- Open access status
- closed
- Identifiers
-
- DOI 10.1016/j.ijrobp.2016.09.031
- PMID 27839910
- Persistent URL
- https://sonar.ch/global/documents/279180
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