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Positron Emission Tomography in Non-Hodgkin's Lymphoma:
Assessment of Chemotherapy With Fluorodeoxyglucose
Wolfgang Römer,
Axel-R. Hanauske,
Sibylle Ziegler,
Ralf Thödtmann,
Wolfgang Weber,
Christoph Fuchs,
Wolfgang Enne,
Michael Herz,
Christoph Nerl,
Manfred Garbrecht, and
Markus Schwaiger
From Nuklearmedizinische Klinik, Klinikum rechts der Isar, Technische
Universität München, Munchen, Germany; I. Medizinische
Klinik, Abteilung Hämatologie und Onkologie, Klinikum rechts der
Isar, Technische Universität München, München,
Germany; Department of Oncology, Universitair Ziekenhuis Gasthuisberg,
Leuven, Belgium; IV. Medizinische Abteilung, Städtisches
Krankenhaus München-Neuperlach; I. Medizinische
Abteilung, Hämatologie, Onkologie und Immunologie,
Städtisches Krankenhaus München-Schwabing.
Positron emission tomography (PET) using F-18
fluorodeoxyglucose (FDG) was performed in non-Hodgkin's lymphoma
(NHL), which is known to be highly responsive to chemotherapy, but also
yields variable treatment results to answer the following questions: (1) What is the extent and time course of changes in FDG utilization in
response to chemotherapy? (2) Are the changes of FDG uptake at early
time points of chemotherapy predictive for therapy outcome? (3) Which
quantitative FDG parameter provides the most sensitive measures of
initial tumor response? Dynamic PET scans were performed in 11 patients
at baseline and 1 and 6 weeks after initiation of chemotherapy. Based
on attenuation corrected images acquired 30 to 60 minutes
postinjection, standardized uptake values (SUV) were determined.
Arterial input functions were estimated from vascular F-18 activity and
the metabolic rates for FDG (MRFDG) were calculated using Patlak
analysis. Before chemotherapy, high FDG uptake was found in all lesions
(SUV[max] 13.3 ± 4.2). Seven days after initiation of chemotherapy,
tumor FDG uptake decreased 60% (SUV[max]). A further decrease
of 42% was seen at day 42 resulting in a total decrease
of 79% from baseline to day 42. During a follow-up of 16.0 ± 4.2 months, six of the 11 patients continued to show complete remission.
Seven days after initiation of chemotherapy, this group of patients
displayed significantly lower mean MRFDG than the group of patients
with relapse. At day 42, all parameters of FDG uptake showed a
significant difference for both patient groups. The relative change of
MRFDG from baseline to day 42, as well as from day 7 to day 42, was
significantly larger as compared with SUV parameters. Standard
chemotherapy of patients with NHL causes rapid decrease of tumor FDG
uptake as early as 7 days after treatment, which continues to decline
during therapy, indicating the sensitivity of metabolic signals to
chemotherapeutic interventions. FDG uptake at 42 days after therapy was
superior in prediction of long-term outcome over day 7 parameters.
Dynamic data acquisition combined with Patlak analysis of FDG kinetics
may provide superior information in therapy monitoring.
Blood, Vol. 91 No. 12 (June 15), 1998:
pp. 4464-4471
© 1998 by The American Society of Hematology.
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