Coleman Morton, Kostakoglu Lale
Center for Lymphoma and Myeloma, Division of Hematology/Oncology, Weill Medical College of Cornell University, New York Presbyterian Hospital, New York, New York, USA.
Cancer. 2006 Oct 1;107(7):1425-8. doi: 10.1002/cncr.22178.
The identification of refractory or nonresponding tumors at an early period during therapy may lead to abbreviation of the current therapy regimen or timely institution of an alternative therapy protocol. Nevertheless, evaluation of treatment response is consequential clinically if the tumor potentially is curable and if effective treatment alternatives exist, so that change in treatment ultimately may increase the probability of response and survival. Hodgkin disease (HD) and diffuse large cell lymphoma (LCL) fit in this model well. However, a subset of patients is either refractory to first-line treatment or develops recurrent disease after an initial remission. Improvements in the treatment of these diseases rely not only on new therapy modalities and accurate assessment of disease extent but also on the assessment of disease extent and on timely and accurate therapy response to enable a more effective management plan. Although the International Prognostic Score for HD and International Prognostic Index for LCL have proved valuable for the stratification of patients in clinical trials, there is variability in outcome within the individual risk groups. Recently, positron emission tomography using (18)F-labeled fluoro-2-deoxy-D-glucose (FDG-PET) imaging has been suggested as a sensitive and relatively more specific means to reflect tumor biologic changes after therapy. With increasingly compelling evidence, early FDG-PET provides a reliable means to assess tumor response accurately that may lead to better management with an effective therapeutic approach.
在治疗早期识别难治性或无反应性肿瘤，可能会导致缩短当前治疗方案或及时采用替代治疗方案。然而，如果肿瘤有潜在治愈可能且存在有效的替代治疗方法，那么评估治疗反应在临床上是很重要的，这样最终改变治疗可能会增加反应和生存的概率。霍奇金病（HD）和弥漫性大细胞淋巴瘤（LCL）很符合这个模型。然而，有一部分患者要么对一线治疗难治，要么在初始缓解后出现复发性疾病。这些疾病治疗的改善不仅依赖于新的治疗方式和对疾病范围的准确评估，还依赖于对疾病范围的评估以及及时准确的治疗反应评估，以便制定更有效的管理计划。尽管HD的国际预后评分和LCL的国际预后指数已被证明在临床试验中对患者分层有价值，但在各个风险组内结果仍存在差异。最近，使用（18）F标记的氟-2-脱氧-D-葡萄糖（FDG-PET）成像的正电子发射断层扫描已被认为是一种反映治疗后肿瘤生物学变化的敏感且相对更特异的手段。随着越来越多的确凿证据，早期FDG-PET提供了一种准确评估肿瘤反应的可靠方法，这可能会通过有效的治疗方法实现更好的管理。
