Department of Medical Oncology, Dr BRA Institute Rotary Cancer Hospital, All India Institute of Medical Sciences, Ansari Nagar, New Delhi 110029, India.
Radiology. 2012 Mar;262(3):956-68. doi: 10.1148/radiol.11110936.
To prospectively examine the roles of positron emission tomography (PET)/computed tomography (CT) and conventional contrast material-enhanced CT at baseline, after two cycles of chemotherapy, and after completion of chemotherapy in pediatric patients with nonlymphoblastic non-Hodgkin lymphoma (NHL) who were treated with similar standard treatment protocols.
The institutional ethics committee approved the study protocol, and all patients were enrolled after written informed consent was obtained. Patients with nonlymphoblastic NHL were prospectively enrolled between January 2008 and March 2010. Patients underwent contrast-enhanced CT and PET/CT for staging and for response assessment after two cycles of chemotherapy (interim) and treatment completion. Complete metabolic response versus no metabolic response at PET/CT and complete response versus no complete response at contrast-enhanced CT was analyzed by using Kaplan-Meier survival analysis.
The final study included 34 patients with nonlymphoblastic NHL (median age, 10.5 years). Baseline PET/CT and contrast-enhanced CT showed concordance in depiction of 112 disease sites; PET/CT depicted 18 more disease sites and two fewer disease sites than contrast-enhanced CT (P = .0003). Disease in five of 34 patients was upstaged, and disease in no patient was downstaged at PET/CT. There was 100% (four of four) concordance between bone marrow involvement at biopsy and stage at PET/CT. The median length of follow-up was 20.3 months. Response at interim PET/CT and contrast-enhanced CT could not predict progression-free survival (PFS) (P = .083 and .18, respectively) or overall survival (OS) (P = .159 and.08, respectively). Posttreatment PET/CT and contrast-enhanced CT findings could predict PFS (P = .036 and .002, respectively) and posttreatment contrast-enhanced CT findings could predict OS (P = .035); however, posttreatment PET/CT findings could not predict OS (P = .067).
PET/CT depicts additional sites compared with contrast-enhanced CT and results in upstaging of disease. Either PET/CT or contrast-enhanced CT may be used for response assessment and prognostication in stage III or IV nonlymphoblastic pediatric NHL.
前瞻性研究在接受相似标准治疗方案的儿童非淋巴母细胞性非霍奇金淋巴瘤（NHL）患者中，正电子发射断层扫描（PET）/计算机断层扫描（CT）和常规造影剂增强 CT 在基线、化疗 2 周期后和化疗完成后在评估中的作用。
机构伦理委员会批准了该研究方案，所有患者均在获得书面知情同意后入组。2008 年 1 月至 2010 年 3 月期间，前瞻性入组非淋巴母细胞性 NHL 患者。患者进行了对比增强 CT 和 PET/CT 分期以及化疗 2 周期后（中期）和治疗完成后的反应评估。通过 Kaplan-Meier 生存分析分析 PET/CT 上完全代谢反应与无代谢反应和增强 CT 上完全缓解与无完全缓解之间的差异。
最终研究纳入 34 例非淋巴母细胞性 NHL 患者（中位年龄 10.5 岁）。基线 PET/CT 和增强 CT 在 112 个疾病部位的显示上具有一致性；PET/CT 显示出 18 个更多的疾病部位，而显示出 2 个更少的疾病部位（P =.0003）。5 例患者的疾病分期升高，而无患者的疾病分期降低。PET/CT 骨髓受累的分期与活检分期具有 100%（4/4）的一致性。中位随访时间为 20.3 个月。中期 PET/CT 和增强 CT 的反应无法预测无进展生存期（PFS）（P =.083 和.18，分别）或总生存期（OS）（P =.159 和.08，分别）。治疗后 PET/CT 和增强 CT 的发现可预测 PFS（P =.036 和.002，分别），治疗后增强 CT 的发现可预测 OS（P =.035）；然而，治疗后 PET/CT 的发现不能预测 OS（P =.067）。
与增强 CT 相比，PET/CT 可显示更多的病变部位，并导致疾病分期升高。在 III 或 IV 期非淋巴母细胞性儿科 NHL 中，可使用 PET/CT 或增强 CT 进行反应评估和预后判断。
