Department of Radiation Oncology, The Methodist Hospital, The Methodist Hospital Research Institute, Houston, TX, USA.
Pediatr Blood Cancer. 2012 Jun;58(6):860-4. doi: 10.1002/pbc.23273. Epub 2011 Aug 8.
To determine how the incorporation of PET-CT changes radiotherapy treatment in pediatric Hodgkin lymphoma.
Fifty-three Hodgkin lymphoma patients with a median age of 14 years (6-21 years) underwent multiagent chemotherapy followed by involved field radiotherapy (IFRT) to initial sites of disease. All patients had conventional staging which included CT scan of the neck, chest, abdomen and pelvis, bone marrow biopsy ± MRI, Gallium scan and bone scan. All had an initial 18-F-fluoro-deoxy-D-glucose (FDG) PET-CT. When there was discordance between conventional staging and PET-CT staging, true sites of disease were determined either by biopsy or response to multiagent chemotherapy.
In 19 of 53 (35.8%) patients, there was discordance between conventional staging and PET-CT findings. The most common location for the 23 sites of discordance were the spleen in 6 (26.1%), neck in 3 (13%), inguinal nodes in 3 (13%) and mediastinum in 3 (13%). A change in stage occurred in 5 (9.4%) as a result of PET-CT imaging. A change in IFRT fields occurred in 9 (17%); eight were more extensive while one was less extensive. For PET-CT, the specificity, sensitivity, positive predictive value and accuracy were 99.5%, 96.3%, 97.9%, and 98.9%.
Incorporation of PET-CT information was found to influence IFRT design in 17% of patients, with most having more extensive radiotherapy fields.
确定 PET-CT 检测结果在儿童霍奇金淋巴瘤中的应用如何改变放射治疗。
53 例中位年龄为 14 岁（6-21 岁）的霍奇金淋巴瘤患者接受多药化疗，然后对疾病初始部位进行累及野放疗（IFRT）。所有患者均进行常规分期，包括颈、胸、腹和骨盆 CT 扫描、骨髓活检+/-MRI、镓扫描和骨扫描。所有患者均进行初始 18-F-氟代脱氧-D-葡萄糖（FDG）PET-CT 检查。如果常规分期和 PET-CT 分期不一致，通过活检或对多药化疗的反应来确定真正的疾病部位。
在 53 例患者中，有 19 例（35.8%）常规分期和 PET-CT 检查结果不一致。23 个不一致部位中最常见的部位为脾脏 6 例（26.1%）、颈部 3 例（13%）、腹股沟淋巴结 3 例（13%）和纵隔 3 例（13%）。PET-CT 成像导致 5 例（9.4%）分期发生变化。IFRT 场发生改变的有 9 例（17%），其中 8 例扩大，1 例缩小。对于 PET-CT，特异性、敏感性、阳性预测值和准确性分别为 99.5%、96.3%、97.9%和 98.9%。
在 17%的患者中，发现 PET-CT 信息的应用会影响 IFRT 设计，其中大多数患者的放疗范围更广泛。
