|
|||||||||
|
|
|
|
|
|
|
|
|
|
|
CLINICAL OBSERVATIONS, INTERVENTIONS, AND THERAPEUTIC TRIALS
From the Department of Internal Medicine I and
Department of Nuclear Medicine, University of Cologne,
Germany; Axiogenesis GmbH, Cologne, Germany; and
Department of Internal Medicine, Klinikum der Stadt
Villingen-Schwenningen, Germany.
Residual mediastinal masses are frequently observed in patients
with Hodgkin disease (HD) after completed therapy, and the discrimination between active tumor tissue and fibrotic residues remains a clinical challenge. We studied the diagnostic value of
metabolic imaging by 18F-fluorodeoxyglucose (FDG) positron
emission tomography (PET) in detecting active mediastinal disease and
predicting relapse. Twenty-eight HD patients with a residual
mediastinal mass of at least 2 cm after initial therapy or after
salvage chemotherapy were prospectively assigned to 29 examinations
with FDG PET and were evaluated as 29 "subjects." Patients were
monitored for at least 1 year after examination and observed for signs
of relapse. Median follow-up was 28 months (range, 16 to 68 months). A
PET-negative mediastinal tumor was observed in 19 subjects, of whom 16 stayed in remission and 3 relapsed. Progression or relapse occurred in 6 of 10 subjects with a positive PET, whereas 4 subjects remained in
remission. The negative predictive value (negative PET result and
remission) at 1 year was 95%, and the positive predictive value
(positive PET result and relapse) was 60%. The disease-free survival
for PET-negative and PET-positive patients at 1 year was 95% and 40%,
respectively. The difference was statistically significant. A negative
FDG PET indicates that an HD patient with a residual mediastinal mass
is unlikely to relapse before 1 year, if ever. On the other hand, a
positive PET result indicates a significantly higher risk of relapse
and demands further diagnostic procedures and a closer follow-up.
(Blood. 2001;98:2930-2934) Hodgkin disease (HD) has become a highly
curable neoplasia. The response and survival rates for newly diagnosed
patients with HD could be increased in recent years using aggressive
polychemotherapy such as the BEACOPP (bleomycin, etoposide,
adriamycin, cyclophosphamide, vincristine, procarbazine, prednisone)
regimen and radiation. BEACOPP showed a significant increase of the
overall survival compared with standard COPP/ABVD (cyclophosphamide,
vincristine, procarbazine, prednisone/doxorubicin, vinblastine,
bleomycin, dacarbazine) in patients with advanced-stage
HD.1 Also, high-dose chemotherapy with autologous stem
cell support can cure many relapsed patients of their
disease.2 However, in up to 64% of all HD cases, computed
tomography (CT) or magnetic resonance imaging (MRI) show remaining
tumor masses after completed treatment,3 although only a
few of these patients will eventually relapse.4,5 These
masses may represent fibrotic tissue or even an active Hodgkin tumor,
but discrimination by CT is usually not possible.5 If the
tumor is easily accessible, as an enlarged inguinal lymph node, the
questionable lesion can be excised and histologically analyzed, whereas
a mediastinal tumor can only be accessed by mediastinoscopy or open
thoracic surgery. Mediastinoscopy is associated with a mortality risk
of up to 0.5%6 and a high failure rate for a pathological
diagnosis because of the relatively small amount of tissue that can be
gained. Open thoracic surgery is an invasive procedure and thus not
desirable for a potentially cured patient. Therefore,
posttreatment mediastinal residues usually require follow-up CT scans
at short time intervals. A delay in the diagnosis of progression or
early relapse may result from this strategy and could mean a loss of
precious time for salvage therapy.
18F-fluorodeoxyglucose (FDG) positron emission tomography
(PET) is a relatively new diagnostic method compared with CT or MRI and
has been reported to detect active tumors in many cancer entities, especially in lymphomas.7-10 There are 2 clinically
relevant indications for FDG PET in patients suffering from HD. First,
FDG PET can be used to improve staging techniques at initial diagnosis
by detecting lesions not detected by CT. Second, FDG PET may be used in
patients with residual tumor masses and could allow discrimination between active lymphoma and nonactive fibrotic tissue. FDG PET for
primary staging of HD has been investigated by several
groups.9,11-15 The aim of the present study was to assess
the diagnostic and prognostic value of FDG PET in HD patients with
residual mediastinal masses after completed therapy.
Patients
FDG PET
Data analysis For all patients, the last date of a clinically complete remission or the first date of a progression and/or relapse after PET was documented. Follow-up evaluation occurred every 3 months by a hematologist and included a physical examination, a complete laboratory work-up, a chest x-ray, and an abdominal ultrasound. Clinically complete remission with a residual mass was defined by the presence of residual mediastinal masses in an additional follow-up CT/MRI scan, no B symptoms, a normal laboratory test, and an abdominal ultrasound without any signs of progressive disease. Progression was defined as a growth of the mediastinal tumor according to CT/MRI within 3 months after completion of therapy. A relapse was characterized by tumor progression later than 3 months after completed therapy. One patient had 2 FDG PET scans after initial therapy and after salvage chemotherapy, respectively. This patient was evaluated as 2 different subjects in the data analysis.Statistics Comparison of the 2 groups (FDG PET-positive or -negative) for the probability of relapse was calculated by Fisher exact tests. The disease-free survival (DFS) was performed with a Kaplan-Meier analysis. The comparison between groups was calculated by a log-rank test. A probability (P value) smaller than .05 was considered statistically significant.
FDG PET and response During the median follow-up of 28 months (range, 16 to 68 months), 9 (31%) of 29 subjects had a progression/relapse after a median of 1.2 months, with a range of 0.1 to 29 months. Five (56%) subjects progressed/relapsed after initial therapy and 4 (44%) after salvage chemotherapy. A biopsy was performed on all of these subjects and confirmed the initial HD subtype.Ten subjects had a positive (34%) and 19 subjects a negative (66%)
FDG PET scan. All positive PET examinations showed only increased
glucose metabolism in the mediastinal area and not in any other region.
The SUV of the positive scans ranged from 1.6 to 6.9 (mean value 3.4).
Of the FDG PET positive subjects, 4 (40%) stayed in remission after a
median observation time of 40 months (range, 16 to 68 months), whereas
6 (60%) progressed or relapsed in a median time of 0.72 months after
therapy (range 0 to 7.5 months). Sixteen (84%) PET-negative subjects
stayed in remission during the entire observation time and 3 (16%)
relapsed. At 1 year, 95% of all PET-negative patients were
disease-free, in contrast to only 40% of patients with a positive PET
scan. These findings were significant (P = .032) and are
summarized in Table 2. A Kaplan-Meier
analysis for the DFS of patients with a negative or positive PET result
is presented in Figure 1. The comparison of the groups (DFS at 1 year 95% vs 40% ± 5%) resulted in a
significant log-rank test with P = .004. The positive
predictive value (defined as "true" positive for relapse) was 60%,
and the negative predictive value (defined as "true" negative for
clinical remission) for a relapse earlier than 1 year after PET was
95% (P = .003).
Sites of relapse and subsequent outcome All 6 subjects with a positive PET scan and recurrent disease relapsed only within the detected mediastinal area and not elsewhere. Of the 3 other relapsing subjects who were PET-negative, 2 suffered from a mediastinal relapse and 1 from a combined mediastinal and liver relapse. All 9 subjects with a recurrent HD were followed for at least 15 months or until death. Three relapsing subjects with a negative PET result could be treated successfully and reached complete remission with a follow-up of 18, 20, and 24 months, whereas only 2 of 6 relapsing subjects with a positive PET reached a complete remission with a follow-up of 36 and 50 months. However, these numbers are too small to reach significance for the analysis of whether PET can predict subsequent outcome. Of the 4 remaining subjects, 1 subject achieved a partial remission with a high-dose chemotherapy and is currently treated with a palliative regimen 15 months after the PET examination. Three subjects died due to progressive disease 1, 4, and 23 months after their PET scans.False-positive PET results Four of the 10 PET-positive examinations were false positive. The SUV of these mediastinal lesions were 3.3, 3.1, 2.4, and 1.6, respectively. One patient had a postchemotherapeutic thymus hyperplasia, which regressed after another 6 months according to a second CT scan. The reasons for misleading PET data in the 3 remaining patients are unknown; clinical causes such as pneumonitis could be ruled out. The PET examinations had been performed 3 to 4 months after completed therapy. The follow-up was 40, 40, and 68 months. Mediastinoscopy with a large biopsy of 21 g of mediastinal mass was performed on one of these patients and revealed tissue with hyaline sclerosis and a massive histiocytic reaction but without any signs of malignancy. Three of the 4 patients with a false-positive PET result had received chemotherapy and additional radiotherapy to the residual mediastinal masses before PET examinations, as shown in Table 3.
False-negative PET results A negative PET result was observed in 19 patients, of whom 3 had a progression or relapse. In one of these patients, PET failed to detect a growing mediastinal tumor that appeared larger in a second CT scan that was done shortly afterward. A CT-controlled biopsy of this lesion confirmed the diagnosis of HD. A second PET scan was performed 2 months after the initial PET and was then positive for the tumor. In the other 2 patients, who had a negative FDG PET, relapse occurred 14 and 29 months after the examination, respectively. Both patients relapsed at the initial mediastinal site. None of the 3 patients with a false-negative PET result had any prior mediastinal irradiation. Table 3 summarizes the characteristics of the patients with a false positive or false-negative PET result.
The analysis of active lymphoma after chemotherapy or radiotherapy has a great clinical impact. Before FDG PET was introduced for the clinical evaluation of patients with lymphoma, tumor activity of residual mediastinal masses after therapy could only be assessed by invasive procedures such as mediastinoscopy or by CT using a "time frame," eg, repeating the procedure at regular intervals to detect a progressive tumor. MRI has been reported to provide prognostic information by discriminating between active malignant tissue and fibrosis/normal tissue in T2-weighted images.17-19 However, MRI has a low sensitivity and is therefore not useful for lymphoma.20 67Gallium scintigraphy is a metabolic imaging technique to detect active tumor tissue, but it has disadvantages such as a low spatial resolution, lack of specificity, and difficulty in quantification of uptake.21 Other significant shortcomings of this technique are shown particularly in the posttherapy setting because the sensitivity depends on the subtype and the location of the lymphoma.22,23 FDG PET imaging has the potential to provide information about active tumor sites in staging9,12,14 as well as in monitoring response to therapy. Moreover, it has been reported to be superior to 67gallium in respect to sensitivity and specificity.24 FDG PET seems to have a value for HD patients with residual tumor burden.8,25-29 Residual mediastinal masses are frequently observed in patients with HD after completed therapy, and the discrimination between active tumor tissue and fibrotic residues remains a clinical challenge. Therefore, we initiated a prospective study to determine the value of FDG PET in these patients. The results of this trial clearly indicate that patients with a negative FDG PET result are unlikely to progress or relapse within a year or longer after therapy. The chance for remaining in remission in the first year after therapy is about 95%. However, if FDG PET identifies an active mediastinal area, the information is questionable because the odds for a relapse and a clinical remission are almost even. Statistically, this was reflected by an excellent negative predictive value of 95% at 1 year for all patients with a "true" negative PET finding and a weak positive predictive value of 60% for all patients with a "true" positive result. Nevertheless, even though the predictive value of PET-positive patients was low, the risk of a mediastinal relapse was significantly higher than for PET-negative patients. This fact justifies additional, perhaps invasive, diagnostic procedures and a closer follow-up. Two of the 6 patients with a relapse who were identified by PET could be successfully treated with a subsequent therapy and were in continuous complete remission. According to our data, false positive FDG uptake seems to be a problem in HD patients. The characteristics of the patients with a false-positive result suggest a younger age compared with the average age in the group of PET-positive patients (23 vs 35 years). Also, they had received initial therapy, 3 of them for a limited and 1 for an advanced stage. The PET examinations had been performed at least 3 months after completed therapy so that treatment-related increased metabolism could be ruled out. The high FDG uptake might be due to immunologic hyperreactivity, especially by the thymus and other lymphatic tissue after chemotherapy or radiotherapy. It is not unusual for HD patients younger than 25 years to present with an enlarged ventral mediastinal mass during the first 6 months after completion of therapy as a sign of thymus hyperplasia.30 This phenomenon may be a reason for false-positive results in FDG PET as described previously.31 In our study, one 18-year-old male had a PET-positive thymus hyperplasia that had decreased in size after another 3 months in a control CT scan. However, the reasons for false-positive PET results in the other 3 patients remain unknown. Several studies have been published dealing with the role of FDG PET for the evaluation of residual tumor masses. Jerusalem et al27 analyzed 19 patients with HD and 35 with non-Hodgkin lymphoma (NHL) in 2 groups, depending on a positive or a negative CT scan. Thirteen HD patients and 11 patients with NHL had a positive CT scan, ie, residual masses. The involved localizations were divided into "thoracic," "abdominal," and "peripheral." Of 5 patients with a positive FDG PET, all relapsed or progressed. Among the 19 PET-negative patients, 5 progressed and 14 remained in remission. Our data are similar to the PET-negative results; only 1 of 19 patients relapsed after 1 year of follow-up in our study, whereas 18 remained disease-free. In contrast, our data, which are specific for mediastinal masses especially in HD patients, showed only a low positive predictive value for FDG PET. In another trial, 16 patients with either HD or NHL had a positive PET with residual masses according to routine methods.8 Nine of these patients remained disease-free. However, 4 of them received radiation after PET, and 2 of the patients had FDG uptake outside the questionable sites. In a more recent study, the same group examined a more homogenous group of 37 HD patients with residual masses. All patients underwent CT and FDG PET during and after therapy.32 The investigators found a negative predictive value of 96% and a positive predictive value of 46%. In our study, we excluded all patients who had an additional radiation after FDG PET before a progressive disease could be documented. Also, none of our patients had any questionable lesions outside the mediastinal area according to the complete CT scan and the thoracic PET. We calculated a similar negative predictive value but a higher positive predictive value compared with de Wit et al.32 This difference could be due to the fact that we required a minimum follow-up of 1 year and focused on mediastinal masses exclusively. The question about future concepts and the role of FDG PET in HD patients with residual masses is not clearly answered. There is an ongoing discussion concerning whether PET is necessary at all for these patients because it is possible to wait for a definite progression of the disease by means of clinical symptoms or a progressive CT result. However, the diagnosis of a relapse should be done as early as possible to ensure a fast therapeutic reaction. Nevertheless, the data of this study point out that one should not rely on a positive FDG PET result exclusively but force pathological diagnosis before any salvage therapy. On the other hand, a clear advantage of FDG PET lies in its high negative predictive value that can reassure both patients and their treating doctors that disease is absent.
Submitted February 9, 2001; accepted July 9, 2001.
This work was supported by the Deutsche Forschungsgemeinschaft and the Deutsche Krebshilfe.
The publication costs of this article were defrayed in part by page charge payment. Therefore, and solely to indicate this fact, this article is hereby marked "advertisement" in accordance with 18 U.S.C. section 1734.
Reprints: Martin R. Weihrauch, Immunologisches Labor Haus 16, Uniklinik Koeln, Joseph-Stelzmann-Str 9, 50924 Koeln, Germany; e-mail: martin.weihrauch{at}uni-koeln.de.
1.
Sieber M, Engert A, Diehl V.
Treatment of Hodgkin's disease: results and current concepts of the German Hodgkin's Lymphoma Study Group.
Ann Oncol.
2000;11(suppl 1):81-85
2.
Josting A, Katay I, Rueffer U, et al.
Favorable outcome of patients with relapsed or refractory Hodgkin's disease treated with high-dose chemotherapy and stem cell rescue at the time of maximal response to conventional salvage therapy (Dex-BEAM).
Ann Oncol.
1998;9:289-295
3.
Radford JA, Cowan RA, Flanagan M, et al.
The significance of residual mediastinal abnormality on the chest radiograph following treatment for Hodgkin's disease.
J Clin Oncol.
1988;6:940-946 4. Israel O, Front D, Lam M, et al. Gallium 67 imaging in monitoring lymphoma response to treatment. Cancer. 1988;61:2439-2443[CrossRef][Medline] [Order article via Infotrieve].
5.
Canellos GP.
Residual mass in lymphoma may not be residual disease.
J Clin Oncol.
1988;6:931-933 6. Sarrazin R, Dyon JF. Mediastinoscopy. Rev Mal Respir. 1992;9:99-110[Medline] [Order article via Infotrieve].
7.
Moog F, Bangerter M, Diederichs CG, et al.
Lymphoma: role of whole-body 2-deoxy-2-[F-18] fluoro-D-glucose (FDG) PET in nodal staging.
Radiology.
1997;203:795-800
8.
de Wit M, Bumann D, Beyer W, Herbst K, Clausen M, Hossfeld DK.
Whole-body positron emission tomography (PET) for diagnosis of residual mass in patients with lymphoma.
Ann Oncol.
1997;8(suppl 1):57-60
9.
Hoh CK, Glaspy J, Rosen P, et al.
Whole-body FDG-PET imaging for staging of Hodgkin's disease and lymphoma.
J Nucl Med.
1997;38:343-348 10. Wiedmann E, Baican B, Hertel A, et al. Positron emission tomography (PET) for staging and evaluation of response to treatment in patients with Hodgkin's disease. Leuk Lymphoma. 1999;34:545-551[Medline] [Order article via Infotrieve].
11.
Jerusalem G, Beguin Y, Fassotte MF, et al.
Whole-body positron emission tomography using 18F-fluorodeoxyglucose compared to standard procedures for staging patients with Hodgkin's disease.
Haematologica.
2001;86:266-273
12.
Partridge S, Timothy A, O'Doherty MJ, Hain SF, Rankin S, Mikhaeel G.
2-fluorine-18-fluoro-2-deoxy-D glucose positron emission tomography in the pretreatment staging of Hodgkin's disease: influence on patient management in a single institution.
Ann Oncol.
2000;11:1273-1279 13. Stumpe KD, Urbinelli M, Steinert HC, Glanzmann C, Buck A, von Schulthess GK. Whole-body positron emission tomography using fluorodeoxyglucose for staging of lymphoma: effectiveness and comparison with computed tomography. Eur J Nucl Med. 1998;25:721-728[CrossRef][Medline] [Order article via Infotrieve].
14.
Bangerter M, Moog F, Buchmann I, et al.
Whole-body 2-[18F]-fluoro-2-deoxy-D-glucose positron emission tomography (FDG-PET) for accurate staging of Hodgkin's disease.
Ann Oncol.
1998;9:1117-1122 15. Jerusalem G, Warland V, Najjar F, et al. Whole-body 18F-FDG PET for the evaluation of patients with Hodgkin's disease and non-Hodgkin's lymphoma. Nucl Med Commun. 1999;20:13-20[Medline] [Order article via Infotrieve].
16.
Hamacher K, Coenen HH, Stocklin G.
Efficient stereospecific synthesis of no-carrier-added 2-[18F]-fluoro-2-deoxy-D-glucose using amino-polyether supported nucleophilic substitution.
J Nucl Med.
1986;27:235-238 17. Nyman R, Forsgren G, Glimelius B. Long-term follow-up of residual mediastinal masses in treated Hodgkin's disease using MR imaging. Acta Radiol. 1996;37:323-326[Medline] [Order article via Infotrieve].
18.
Nyman RS, Rehn SM, Glimelius BL, et al.
Residual mediastinal masses in Hodgkin disease: prediction of size with MR imaging.
Radiology.
1989;170:435-440 19. Glazer HS, Lee JK, Levitt RG, et al. Radiation fibrosis: differentiation from recurrent tumor by MR imaging. Radiology. 1985;156:721726.
20.
Hill M, Cunningham D, MacVicar D, et al.
Role of magnetic resonance imaging in predicting relapse in residual masses after treatment of lymphoma.
J Clin Oncol.
1993;11:2273-2278 21. Kostakoglu L, Goldsmith SJ. Fluorine-18 fluorodeoxyglucose positron emission tomography in the staging and follow-up of lymphoma: is it time to shift gears? Eur J Nucl Med. 2000;27:1564-1578[CrossRef][Medline] [Order article via Infotrieve].
22.
Kostakoglu L, Yeh SD, Portlock C, et al.
Validation of gallium-67-citrate single-photon emission computed tomography in biopsy-confirmed residual Hodgkin's disease in the mediastinum.
J Nucl Med.
1992;33:345-350 23. Setoain FJ, Pons F, Herranz R, et al. 67Ga scintigraphy for the evaluation of recurrences and residual masses in patients with lymphoma. Nucl Med Commun. 1997;18:405-411[Medline] [Order article via Infotrieve].
24.
Paul R.
Comparison of fluorine-18-2-fluorodeoxyglucose and gallium-67 citrate imaging for detection of lymphoma.
J Nucl Med.
1987;28:288-292 25. Mainolfi C, Maurea S, Varrella P, et al. [Positron-emission tomography with fluorine-18-deoxyglucose in the staging and control of patients with lymphoma. Comparison with clinico- radiologic assessment]. Radiol Med (Torino). 1998;95:98-104[Medline] [Order article via Infotrieve]. 26. Cremerius U, Fabry U, Kroll U, et al. Clinical value of FDG PET for therapy monitoring of malignant lymphoma- -results of a retrospective study in 72 patients. Nuklearmedizin. 1999;38:24-30[Medline] [Order article via Infotrieve].
27.
Jerusalem G, Beguin Y, Fassotte MF, et al.
Whole-body positron emission tomography using 18F-fluorodeoxyglucose for posttreatment evaluation in Hodgkin's disease and non-Hodgkin's lymphoma has higher diagnostic and prognostic value than classical computed tomography scan imaging.
Blood.
1999;94:429-433 28. Cremerius U, Fabry U, Neuerburg J, Zimny M, Osieka R, Buell U. Positron emission tomography with 18F-FDG to detect residual disease after therapy for malignant lymphoma. Nucl Med Commun. 1998;19:1055-1063[Medline] [Order article via Infotrieve].
29.
Zinzani PL, Magagnoli M, Chierichetti F, et al.
The role of positron emission tomography (PET) in the management of lymphoma patients.
Ann Oncol.
1999;10:1181-1184 30. Shin MS, Ho KJ. Diffuse thymic hyperplasia following chemotherapy for nodular sclerosing Hodgkin's disease: an immunologic rebound phenomenon? Cancer. 1983;51:30-33[CrossRef][Medline] [Order article via Infotrieve].
31.
Weinblatt ME, Zanzi I, Belakhlef A, Babchyck B, Kochen J.
False-positive FDG-PET imaging of the thymus of a child with Hodgkin's disease.
J Nucl Med.
1997;38:888-890
32.
de Wit M, Bohuslavizki KH, Buchert R, Bumann D, Clausen M, Hossfeld DK.
18FDG-PET following treatment as valid predictor for disease-free survival in Hodgkin's lymphoma.
Ann Oncol.
2001;12:29-37
© 2001 by The American Society of Hematology.
| |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
 |
|
 |
|
  H. Mocikova, P. Obrtlikova, B. Vackova, and M. Trneny Positron emission tomography at the end of first-line therapy and during follow-up in patients with Hodgkin lymphoma: a retrospective study Ann. Onc., November 9, 2009; (2009) mdp522v1. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
D. J. Sher, P. M. Mauch, A. Van Den Abbeele, A. S. LaCasce, J. Czerminski, and A. K. Ng Prognostic significance of mid- and post-ABVD PET imaging in Hodgkin's lymphoma: the importance of involved-field radiotherapy Ann. Onc., November 1, 2009; 20(11): 1848 - 1853. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 D. Delbeke, S. Stroobants, E. de Kerviler, C. Gisselbrecht, M. Meignan, and P. S. Conti Expert Opinions on Positron Emission Tomography and Computed Tomography Imaging in Lymphoma Oncologist, October 1, 2009; 14(suppl_2): 30 - 40. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
J. Markova, C. Kobe, M. Skopalova, K. Klaskova, K. Dedeckova, A. Plutschow, H. T. Eich, M. Dietlein, A. Engert, and T. Kozak FDG-PET for assessment of early treatment response after four cycles of chemotherapy in patients with advanced-stage Hodgkin's lymphoma has a high negative predictive value Ann. Onc., July 1, 2009; 20(7): 1270 - 1274. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 M. Hutchings and S. F. Barrington PET/CT for Therapy Response Assessment in Lymphoma J. Nucl. Med., May 1, 2009; 50(Suppl_1): 21S - 30S. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 C. Kobe, M. Dietlein, J. Franklin, J. Markova, A. Lohri, H. Amthauer, S. Klutmann, W. H. Knapp, J. M. Zijlstra, A. Bockisch, et al. Positron emission tomography has a high negative predictive value for progression or early relapse for patients with residual disease after first-line chemotherapy in advanced-stage Hodgkin lymphoma Blood, November 15, 2008; 112(10): 3989 - 3994. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
R. L. Elstrom, J. P. Leonard, M. Coleman, and R. K. J. Brown Combined PET and low-dose, noncontrast CT scanning obviates the need for additional diagnostic contrast-enhanced CT scans in patients undergoing staging or restaging for lymphoma Ann. Onc., October 1, 2008; 19(10): 1770 - 1773. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 A V Martin and B Sharma Positron emission tomography and CT in the management of lymphoma Imaging, September 1, 2008; 20(3): 169 - 175. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
T. Terasawa, T. Nihashi, T. Hotta, and H. Nagai 18F-FDG PET for Posttherapy Assessment of Hodgkin's Disease and Aggressive Non-Hodgkin's Lymphoma: A Systematic Review J. Nucl. Med., January 1, 2008; 49(1): 13 - 21. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 J. K. Schwarz, B. A. Siegel, F. Dehdashti, and P. W. Grigsby Association of Posttherapy Positron Emission Tomography With Tumor Response and Survival in Cervical Carcinoma JAMA, November 21, 2007; 298(19): 2289 - 2295. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
P. Seam, M. E. Juweid, and B. D. Cheson The role of FDG-PET scans in patients with lymphoma Blood, November 15, 2007; 110(10): 3507 - 3516. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 R. Advani, L. Maeda, P. Lavori, A. Quon, R. Hoppe, S. Breslin, S. A. Rosenberg, and S. J. Horning Impact of Positive Positron Emission Tomography on Prediction of Freedom From Progression After Stanford V Chemotherapy in Hodgkin's Disease J. Clin. Oncol., September 1, 2007; 25(25): 3902 - 3907. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
M. E. Juweid, S. Stroobants, O. S. Hoekstra, F. M. Mottaghy, M. Dietlein, A. Guermazi, G. A. Wiseman, L. Kostakoglu, K. Scheidhauer, A. Buck, et al. Use of Positron Emission Tomography for Response Assessment of Lymphoma: Consensus of the Imaging Subcommittee of International Harmonization Project in Lymphoma J. Clin. Oncol., February 10, 2007; 25(5): 571 - 578. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
B. D. Cheson, B. Pfistner, M. E. Juweid, R. D. Gascoyne, L. Specht, S. J. Horning, B. Coiffier, R. I. Fisher, A. Hagenbeek, E. Zucca, et al. Revised Response Criteria for Malignant Lymphoma J. Clin. Oncol., February 10, 2007; 25(5): 579 - 586. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
E. J. Dann, R. Bar-Shalom, A. Tamir, N. Haim, M. Ben-Shachar, I. Avivi, T. Zuckerman, M. Kirschbaum, O. Goor, D. Libster, et al. Risk-adapted BEACOPP regimen can reduce the cumulative dose of chemotherapy for standard and high-risk Hodgkin lymphoma with no impairment of outcome Blood, February 1, 2007; 109(3): 905 - 909. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
P. L. Zinzani, M. Tani, S. Fanti, L. Alinari, G. Musuraca, E. Marchi, V. Stefoni, P. Castellucci, M. Fina, M. Farshad, et al. Early positron emission tomography (PET) restaging: a predictive final response in Hodgkin's disease patients Ann. Onc., August 1, 2006; 17(8): 1296 - 1300. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 M. E. Juweid Utility of Positron Emission Tomography (PET) Scanning in Managing Patients with Hodgkin Lymphoma Hematology, January 1, 2006; 2006(1): 259 - 265. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 M. Tatsumi, C. Cohade, Y. Nakamoto, E. K. Fishman, and R. L. Wahl Direct Comparison of FDG PET and CT Findings in Patients with Lymphoma: Initial Experience Radiology, December 1, 2005; 237(3): 1038 - 1045. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 W A Weber PET for response assessment in oncology: radiotherapy and chemotherapy Br. J. Radiol., November 1, 2005; Supplement_28(1): 42 - 49. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
M. J. Reinhardt, C. Herkel, C. Altehoefer, J. Finke, and E. Moser Computed tomography and 18F-FDG positron emission tomography for therapy control of Hodgkin's and non-Hodgkin's lymphoma patients: when do we really need FDG-PET? Ann. Onc., September 1, 2005; 16(9): 1524 - 1529. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
M. Hutchings, N. G. Mikhaeel, P. A. Fields, T. Nunan, and A. R. Timothy Prognostic value of interim FDG-PET after two or three cycles of chemotherapy in Hodgkin lymphoma Ann. Onc., July 1, 2005; 16(7): 1160 - 1168. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
W. A. Weber Use of PET for Monitoring Cancer Therapy and for Predicting Outcome J. Nucl. Med., June 1, 2005; 46(6): 983 - 995. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 G. J. Kelloff, J. M. Hoffman, B. Johnson, H. I. Scher, B. A. Siegel, E. Y. Cheng, B. D. Cheson, J. O'Shaughnessy, K. Z. Guyton, D. A. Mankoff, et al. Progress and Promise of FDG-PET Imaging for Cancer Patient Management and Oncologic Drug Development Clin. Cancer Res., April 15, 2005; 11(8): 2785 - 2808. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 T. Kazama, S. C. Faria, V. Varavithya, S. Phongkitkarun, H. Ito, and H. A. Macapinlac FDG PET in the Evaluation of Treatment for Lymphoma: Clinical Usefulness and Pitfalls RadioGraphics, January 1, 2005; 25(1): 191 - 207. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
D. J. Straus, C. S. Portlock, J. Qin, J. Myers, A. D. Zelenetz, C. Moskowitz, A. Noy, A. Goy, and J. Yahalom Results of a prospective randomized clinical trial of doxorubicin, bleomycin, vinblastine, and dacarbazine (ABVD) followed by radiation therapy (RT) versus ABVD alone for stages I, II, and IIIA nonbulky Hodgkin disease Blood, December 1, 2004; 104(12): 3483 - 3489. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
R. Munker, J. Glass, L. K. Griffeth, T. Sattar, R. Zamani, M. Heldmann, R. Shi, and D. L. Lilien Contribution of PET imaging to the initial staging and prognosis of patients with Hodgkin's disease Ann. Onc., November 1, 2004; 15(11): 1699 - 1704. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
M. Bendandi, S. A. Pileri, and P. L. Zinzani Challenging paradigms in lymphoma treatment Ann. Onc., May 1, 2004; 15(5): 703 - 711. [Full Text] [PDF]
|
|
|
|
|
|
R. M. Meyer, R. F. Ambinder, and S. Stroobants Hodgkin's Lymphoma: Evolving Concepts with Implications for Practice Hematology, January 1, 2004; 2004(1): 184 - 202. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
J. W. Friedberg and V. Chengazi PET Scans in the Staging of Lymphoma: Current Status Oncologist, October 1, 2003; 8(5): 438 - 447. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
K. Spaepen, S. Stroobants, P. Dupont, P. Vandenberghe, J. Maertens, G. Bormans, J. Thomas, J. Balzarini, C. De Wolf-Peeters, L. Mortelmans, et al. Prognostic value of pretransplantation positron emission tomography using fluorine 18-fluorodeoxyglucose in patients with aggressive lymphoma treated with high-dose chemotherapy and stem cell transplantation Blood, July 1, 2003; 102(1): 53 - 59. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
L. Kostakoglu and S. J. Goldsmith 18F-FDG PET Evaluation of the Response to Therapy for Lymphoma and for Breast, Lung, and Colorectal Carcinoma J. Nucl. Med., February 1, 2003; 44(2): 224 - 239. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
G. Jerusalem, Y. Beguin, M. F. Fassotte, T. Belhocine, R. Hustinx, P. Rigo, and G. Fillet Early detection of relapse by whole-body positron emission tomography in the follow-up of patients with Hodgkin's disease Ann. Onc., January 1, 2003; 14(1): 123 - 130. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
B. G.M. Durie, A. D. Waxman, A. D'Agnolo, and C. M. Williams Whole-Body 18F-FDG PET Identifies High-Risk Myeloma J. Nucl. Med., November 1, 2002; 43(11): 1457 - 1463. [Abstract] [Full Text] [PDF]
|
|
| ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
 |
 |
 |
|||||||
 |
 |
 |
 |
 |
 |
 |
 |
||
| Copyright © 2001 by American Society of Hematology Online ISSN: 1528-0020 | |||||||||
Top
Abstract
Introduction